: STATE OF FLORIDA DIVISION OF ADMINSTRATIVE HEARINGS LAFAYETTE HEALTH INVESTORS, L.C. d/b/a, LAFAYETTE HEALTH CARE CENTER Petitioner, vs. DLGD Clete { CASE NO.: 02-3266MPI JUDGE: Don W. Davis oO AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-03-0 193-SMDA nett ADMINISTRATION, 2a a mA Respondent. / FINAL ORDER no ww 61 8 -_ THE PARTIES resolved all disputed issues and executed a settlement agreement whi is attached and incorporated by reference. The parties are directed to comply with the terms of ch the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE AND ORDERED on this the 18th dayof_ February Tallahassee, Florida. ‘how Rhonda M. Medows, MD4 Secretary Agency for Health Care Administration ; rot in 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: Michael J. Bittman, Esquire Gray, Harris & Robinson, P.A. 301 East Pine Street, Suite 1400 Orlando, Florida 32801 Anthony L. Conticello, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice) Judith E. Hefren, Deputy Inspector General Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS #5 Tallahassee, Florida 32308 (Interoffice) Willie Bivins Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration 2727 Mahan Drive, MS #14 (Interoffice) Robert Maryanski Medicaid Program Development Agency for Health Care Administration 2727 Mahan Drive, MS #20 (Interoffice) Don W. Davis Administrative Law Judge DOAH (Interoffice) Lisa Milton Agency Analyst (Interoffice) CERTIFICATE OF SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the / D day o Dk Tealand McCharen, oe Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 20 GRAY, HARRIS & ROBINSON, BA RECEIVED wer 34 GENERAL COUNSEL P.O, BON 306% ORLANDO. FLORIDA 32802-3068 G Tl tet 4CT-843-8880 RAY ARRIS DEC -5 2002 FAN 407-244-8000 ATTORNEYS AT LAW Bee eras harrison Agency for Health Care Administration WETTER WREOT irae (407) 244-5681 December 4, 2002 Pear ani ness mbittman@grayharris.com VIA FEDERAL EXPRESS Anthony L. Conticello, Esq. Assistant Attorney General Agency for Health Care Administration 2727 Mahan Drive. Bldg #3 Tallahassee, FL 32308 re: Lafayette Health Investors, L.C., d/b/a Lafayette Health Care Center — v. Agency for Health Care Administration, DOAH Case No. 02-3266 (Medicaid Audit Appeal for fiscal year ending January 31, 1999) Dear Anthony: Enclosed please find the original settlement agreement executed by our client, Lafayette Health Investors, L.D., d/b/a Lafayette Health Care Center. Please have page 7 signed on behalf of the Respondent at your early convenience. We look forward to receiving a fully signed copy of the settlement agreement. Thank you for your courtesy. Very truly yours, Meda §} Sou Michael J. Bittman (SIGNED IN ABSENCE) MJB/jm Encl. 255003-15\# 122334v1 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS LAFAYETTE HEALTH INVESTORS, L.C., d/b/a LAFAYETTE HEALTH CARE CENTER, Petitioner, CASE NO: 02-3266MPI vy. JUDGE: Don W. Davis AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and LAFAYETTE HEALTH INVESTORS, L.C., d/b/a LAFAYETTE HEALTH CARE CENTER (“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 cost and burdens of litigation. 2. PROVIDER (#213179) is a Medicaid provider in the State of Florida, operating a facility that was audited by the Agency. 3. The Agency conducted audit engagement no. NH00-143R of the PROVIDER’S cost report for the audit period ended January 31, 1999, 4. On June 25, 2002, AHCA issued an Audit Report to PROVIDER notifying it that a review of the cost report revealed that, in its opinion, some claims in whole or in part were not reimbursable by Medicaid (the “Audit Report”). The Agency further notified PROVIDER of the adjustments that AHCA was making to the cost report. In response to the Audit Report, PROVIDER filed a timely petition for administrative hearing that was referred to the Division of Administrative hearings and was assigned Case No. 02-3266MPI. In its petition for administrative hearing, PROVIDER identified specific adjustments that it appealed. Subsequent to issuance of the Audit Report, AHCA and PROVIDER exchanged documents and discussed the single adjustment that is at issue. As a result of the aforementioned exchanges, the parties agree that the Agency’s adjustment # 1 will be reduced from 20,258.00 to $0.00. The parties agree that there will be no changes in any of the other audit adjustments that AHCA has made in the Audit Report. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree that the adjustment resolutions, as set forth above, will resolve and settle this case completely. As such, this agreement constitutes PROVIDER’S withdrawal of the petition for administrative hearing, with prejudice. PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rate for this time period, and issue a notice of the recalculation. Where PROVIDER was overpaid, PROVIDER will remit payment to the Agency in the full amount of the overpayment within thirty (30) days of such notice. Where 11, 12. 13. PROVIDER was underpaid, AHCA will remit payment to the PROVIDER in the full amount of the underpayment within forty-five (45) days of such notice. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 PROVIDER: LAFAYETTE HEALTH INVESTORS, L.C Route 3, Box 5 Mayo, FL 32066 And payment shall clearly indicate that it is per a settlement agreement, shall reference the Case Number, and shall reference the audit/engagement number. 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. 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. This settlement 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. 15. 16. 18. Each party shall bear its own attorneys’ fees and costs, if any. 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. The parties further agree that a facsimile or photocopy reproduction of this agreement shall be sufficient for the parties to enforce the agreement. PROVIDER agrees, however, to forward a copy of this agreement to AHCA with original signatures, and understands that a Final Order may not be issued until said original agreement is received by AHCA. 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. This Agreement constitutes the entire agreement between PROVIDER and the 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 the 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. 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 and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and 20. 21, 22. contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 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 rules of the Agency regarding this proceedings and any and all issues raised herein, other than enforcement of this Agreement. PROVIDER further agrees that the Agency shall issue a Final Order which is consistent with the terms of this settlement, that adopts this Agreement and closes this matter. 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. To the extent that any provision of this Agreement is prohibited by law for any Treason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. LAFAYETTE HEALTH INVESTORS, L.C., d/b/a LAFAYETTE HEALTH CARE CENTER, Dated: Lirt ¢ Danpy Carpenter Its: Chief Financial Officer , 2002 , 2002 Pockal, ithe Dated: ll-~6 ICHAEL J{BITTMAN, ESQ. Attomey for Lafayette Health Care Center AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 (Pov BOB SHARPE Deputy Secretary, Medicaid » CONTICELLO Assistant General Counsel # 113675 v1 2 Dated: [2 ; 2098 Dated: at LE a0 paea, __ / 2 / 7 2002

Docket for Case No: 02-003266MPI