STATE OF FLORIDA Phe | AGENCY FOR HEALTH CARE ADMINISTRATION LIFE CARE CENTER OF WELLS CROSSING, a ~ Petitioner, “Pm ber Wet © DOAH Case. No. 02-3143MPIL... = Audit Period: July 31, 1999 Vv. Engagement No. NH01-006S~ ~ STATE OF FLORIDA, Provider No. 213161 AGENCY FOR HEALTH CARE Rea ett te JHE « ae TEYCDor} | iL ATCA Ce by ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved al! disputed issues and executed a settlement agreement, which is attached and incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE AND ORDERED on this the ¢ day of dune. , 2003, in Tallahassee, Florida. Rhonda M. Medows, MD, S&cretary Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies Furnished to: Keith Goss, Sr. V.P. Reimbursement Life Care Centers of America 3001 Keith Street, NW P.O. Box 3480 Cleveland, Tennessee 37320-3480 Susan Felker-Little, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 P. Michael Ruff Administrative Law Judge The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Lisa Milton 2727 Mahan Drive, Mail Stop #21 Tallahassee, Florida 32308 Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing has been 6 (harlae SIN TST Lealand McCharen, Agency Clérk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 pets: rey : ror STATE OF FLORIDA 03 UN 10 AH Io: 26 AGENCY FOR HEALTH CARE ADMINISTRATION a LIFE CARE CENTER OF WELLS CROSSING, Petitioner, DOAH Case No. 02-3143MPI Vv. Audit Period: July 31, 1999 Engagement No. NH01-006S STATE OF FLORIDA, Provider No. 213161 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA ~~ or the Agency), and LIFE CARE CENTER OF WELLS CROSSING (PROVIDER), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into between the parties for the purpose of avoiding the costs and burdens of litigation 2. PROVIDER is a Medicaid provider in the State of Florida, operating as nursing home, that was audited by the Agency. 3. The Agency conducted an audit of the PROVIDER’S cost report for the audit period ended July 31, 1999. 4. In its Audit Report issued on March 18, 2002, AHCA notified PROVIDER that a review of the PROVIDER’S cost report revealed that, in its opinion, some claims in whole or in part were not reimbursable by Medicaid. The Agency further notified PROVIDER of the LLC OF WELLS CROSSING v, AHCA July 31, 1999/NH01-006S SETTLEMENT AGREEMENT adjustments that AHCA was making to its cost report. In response to the Audit Report, PROVIDER filed a timely petition for administrative hearing and the matter was referred to the Division of Administration Hearings for the assignment of an Administrative Law Judge and was assigned DOAH Case No. 02-3143MPI. 5. Subsequent to issuance of the Audit Report, AHCA and PROVIDER exchanged documents and discussed adjustments that were at issue, and DOAH relinquished jurisdiction to AHCA for the execution of a settlement agreement by all parties. 6. As a result of the aforementioned exchanges, the parties agree that the Agency’s adjustments that were the subject of these proceedings, as they relate to the PROVIDER’S cost report for the audit period ended July 31, 1999, shall be as follows: a. Audit Adjustment #12 will be removed. 7. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree that the adjustment resolution, as set forth above, will resolve and settle this case completely. As such, this Agreement constitutes PROVIDER’S withdrawal of PROVIDER’S petition for administrative hearing, with prejudice. 8. PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rate for the time period involved in this matter, and issue a notice of the recalculation. Where PROVIDER was overpaid, PROVIDER will remit payment to the Agency in the full amount of the cost within thirty (30) days of such notice. Where PROVIDER was underpaid, AHCA will remit payment to the PROVIDER in the full amount of the underpayment within LLC OF WELLS CROSSING v. AHCA July 31, 1999/NHO1-006S SETTLEMENT AGREEMENT Page 3 of 6 forty-five (45) days of such notice. 9. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 PROVIDER Life Care Center of Wells Crossing 355 Crossing Boulevard Orange Park, FL 32073 Payment shall clearly indicate that it is pursuant to a settlement agreement and shall reference the audit period/engagement number (Audit Period: July 31, 1999/Engagement No. NH01- 006S). 10. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute PROVIDER’S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this Agreement from any monies due and owing to PROVIDER for any Medicaid claims. 11, | PROVIDER and AHCA reserve the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. LLC OF WELLS CROSSING v. AHCA July 31, 1999/NHO1 -006S SETTLEMENT AGREEMENT Page 4 of 6 12. This Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this Agreement. 13. Each party shall bear its own attorneys’ fees and costs, if any. 14. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. PROVIDER agrees to forward a copy of this Agreement to AHCA with original signatures, and understands that a Final Order may not be issued until the Agreement with ori ginal signatures is received by AHCA. 15. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida. 16. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 17. This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions, as to facts LLC OF WELLS CROSSING v. AHCA July 31, 1999/NH01-006S SETTLEMENT AGREEMENT Page 5 of 6 and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof, 18. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or tules of the Agency regarding this proceeding and any and all issues raised herein, other than enforcement of this Agreement. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter that is consistent with the terms of this Agreement in any forum now or in the future available to it, including the ri ght to any administrative proceeding, circuit or federal court action or any appeal. 19. This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it. 20. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shail not affect any other provision of this Agreement. 21. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. LLC OF WELLS CROSSING v. AHCA July 31, 1999/NHO1-006S SETTLEMENT AGREEMENT Page 6 of 6 22. All times stated herein are of the essence of this Agreement. 23. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. LIFE CARE CENTER OF WELLS CROSSING Ke lect bene Dated: By: Keseh Goss (print name above) Its: Sr. Vice Prece. hol if heiabars er enk (print title above) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 3230845403 Dated: Bob Sharpe Deputy Secretary, Medicaid Wp Lor Dated: Valda Clark Christian General! Counsel Qt ZL) , 2003 Lf 2 2003 1 7 Dig FT , 2003 AAA vac L/22 10 Sawane Cc. a Assistant General Counsel

Docket for Case No: 02-003143MPI