L4 FYI EXHIBIT "A" STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Division of Administrative Hearings STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VS. HCE Windmoor Healthcare, Inc. d/b/a/ Windmoor Healthcare of Miami . Respondent. / I | ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty-one (21) days from receipt of this COMPLAINT, the AGENC'Y FOR HEALTH CARE ADMINISTRATION ("Agency") intends to impose an administrative fine for each day of non-compliance upon Windmoor Healthcare, Ins. (H 10-4005) ("Respondent") for violations involving Prior Year Reports. As grounds for the imposition of this adminjstrative fme, the Agency will show: 1. Respondent is a hospital as defined by § 395.002(12), Florida Statutes and is located at 186] N.W. South River Drive, Miami, FL 33125. 2. Pursuant to Section 408.061(4)(a), Florida Statutes, and Rule 59E-5.201, Florida Administrative Code, Respondent is required to file with the Agency within 120 days subsequent to the end of its fiscal yenr, its Prior Year Report which consists of an original and one copy of its actual report prepared and submitted in compliance with the Florida Hoapital Uniform Reporting System Mianual on forms adapted by the Agency, two copies of its audited financia] statemenis, and one copy of its Medicare cost report. 3. Respondent failed to submit a complete and accurate Prior Year Report for its 2001 fiscal year by 11/27/2001. Pursuant to Rule 598-2.024(5), Florida Administrative Cade, the Agency sent 2 deemed not filed notice to Respondent on 12/06/2001, which specified the corrections needed to bring its report into compliance with statutory and rule requirements, altowed ten (10) working days to provide the agency with the requested information, and gave notice that Respondent would be subject to imposition of an administrative fine if the requested information was not timely filed, A copy of the deemed not filed notice is attached hereto as Exhibit “A” and incorporated herein by reference. Respondent received the deemed not filed notice on 12/08/2001. 4, Respondent failed to submit the Prior Year Report, Audited Financial Statements, and Medicare Cost Report to the Agency within ten (10) working days from the date of its receipt of the notice of violation as required therein, and, as of the date of this administrative complaint, has still not complied with the requirements of law and rules as set forth herein and in the notice of violation, 5. Based on the foregoing, Respondent has violated: §408.061(4)(a), Florida Statutes and Rule 598-5.201, Florida Administrative Code, and Respondent is thereby subject to the penalties set forth in Section 408.08, Florida Statutes, which provides that any hospital which refuses to file a report, fails to timely file a report, files ¢ false report, or files an incomplete report shal! be punished by a fine not to exceed $1,000 per day for each day in violation, to be fixed, imposed, and collected by the Agency. Each day in violation shall be considered a separate offense. 6. Respondent's violations constitute a: second occurrence for the purpose of calculating finas pursuant to Rule 39E-2.025, Florida Administrative Cade. 7. Pursuant to Ruie S9E-2.024(5}, Florida Administrative Code, the imposition of an administrative fine will be ealculated trom October 28%, 2001, the original due date of the report. Respondent's faihure to file its 2001 Prior Year Report in a timely manner is subject to a fine of $40.00 per day pursuant to Rule 59E-2.025 (1)(@), Florida Administrative Code. In addition to the foregoing, if a complete Teport is not filed prior to the entry of the Order sought herein, Respondent shal! be subject to 4 ine of $25,000 for failure to file a report as provided in Rule 59E-2.025(c), Florida Administrative Code, &. YOU ARE FURTHER NOTIFIED that you have a right to request an administrative heating pursuant to Section 120.57, Florida Statutes, to be represented by counsel or other qualified representative (at your own expense), to take testimony, to cal! or cross-examine witnesses, to have subpoena and/or subpoena duces tecum issued, and to present written evidence or argument if you request a hearing. Chapter 59-1, Part Tl, Florida _Administrative Code, constitutes the Agency's procedural rule for administrative ‘proceadings resulting from this complaint, In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, your request for an administrative hearing must conform to the requirements of Rule 28-106.201 » Florida Administrative Code, and must set forth with specificity disputed issues of material fact. Failure to set forth such disputed issues of material fact may be treated by the Agency as an election by you of an informal procesding under §120.57(2), Florida Statutes. All requests for a hearing shall be made to: Agency for Health Care Administration, MS #3, Bidg, #3, 2727 Mahan Drive, Tallahassee, Florida 32308, Attention: Office of the General Counsel, Agency Clerk, copies to Christopher J. Augsburger, Regulatory Analyst Supervisor, Bureau, Health Facility Regulation, 9. All payments of administrative fines shall be by check or money order payable to the Agency for Health Care Administration, Reference shall be made to Respondent's nam, facility number, and the cuse number on this Complaint, and shall be sent to the Agency for Health Care Administration, Bureau Heulth Facility Regulation, Fort Knox Office Plaza, Building #1, MS #28, 2727 Mahan Drive, Tallahassee, Florida 32308, Attention: Christopher J. Augsburger, Regulatory Analyst Supervisor, Bureau, Health Facility Regulation. 10. YOU ARE FURTHER NOTIFIED that failure to request a hearing within twenty-one (21) days of service of this Complaint will result in an admission of the facts alleged in the Complaint and the entry of a Final Order by the Agency, THEREBY CERTIFY that a true copy hereof was sent by U.S. Certified Mail, Retum Receipt Requested to C, William Brett, Chief Executive Officer, Windmoor Healthcare of Clearwater, 11300 U.S, 19 North, Clearwater, FL, 34624 this 9" day of August 2002. Cropher I Aaesbatger Regulatory Analyst Supervisor Bureau Health Facility Regulation Agency for Health Care Administration STATE OF FLORIDA HCA AGENCY FOR HEALTH CARE ADMINISTRATION JEB SUSH, GOVERNOR RHONDA Mi. MEDOWS, MD, FAARP, SECRETARY ‘ED y CERTIFIED MAIL EXHIBIT “a” December 6, 2001 Audrey Delgado Chief Executive Officer Windmoor Healthcare of Miami, Inc. 18651 N.W. South River Drive Miami, FL 33125 RE: 2001 Prior Year Report, FYE: 06/30/01 H 104005 : . Deemed Nat Filed Notice of Violation Dear Ms. Delgado: Pursuant io mule 59E-2.024, 59E-5.103, 59B-5.204 and 59B-5.206 F.A.C., the above referenced report has been found incomplete and deemed not filed for the following reason(s): Ek, Prior Year Actual Report . Pursuant to rule S9E-S.201 and 59E-5.206 F.A.C., your hospital is required to submit to the Agency its actual report in electronic format. Please submit (1) 3.5 inch diskerte pursuant to the formatting requirements provided in Rule 59E-5.206, a of . a— oN Audited financial Statements ; ' Pursuant to rule 59E-5.20] F.A-C., your hospital is required to submit the hospital's audited financial statements. Please submit (1) copy of the audited financial statements. Draft copies are not accapted, ' 2 Medicare Cost Report Pursuant to rule 59E-5.201 F.A.C., your hospital is required to submit (1) copy of the Medicare Cost Report, Please submit (1) copy of the Medicare Cost Report. 2717 Mahan Drive — Mai) Stop #2E Visit ARCA Online at Talishascee, FL 32308 www dhe. state Slur Pursuant to rule 592-2.024(5), please submit the required information within 10 working days from the date you receive this letter. Any subsequent administrative fines will be imposed from the due date of the report. Section 408,08 of the Florida Statutes provides that any hospital which refuses to file on a timely basis reports or other information required to be filed with the Agency, shall be punished by a fine not to exceed $1,000 per day for each day in violation. Failure to provide these corrections will result in the matter being forwarded to our jegal counsel for appropriate action, Thank you very much for your cooperation, If you have any questions, please contact me at 850- 922. . , Sincerely, aN Jef¥ Banka Regulatory Analyst 663) Amey [9g ulod Sd “Hay mend pul ry ANCA ; {HAHCIAL ARALYSIS. az# dois wei ‘gasseueHel ill FOINRS Wis, SUNG GaN)

Docket for Case No: 02-003949