STATE OF FLORIDA ns DIVISION OF ADMINISTRATIVE HEARINGS P&D PHARMACY DISCOUNT, INC. mS &, d/b/a ISABEL PHARMACY, vot Petitioner, Ch c bea. CASE NO. 02-4299MPI vs. PROVIDER NO. 105762600 STATE OF FLORIDA, AUDIT C.I. NO. 00-1709-000-3 AGENCY FOR HEALTH CARE Rendition No. AHCA-03- -S-MDP ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement, which is 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 77_ day of for | , 2003, in Tallahassee, Florida. i a MD, Secretary 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Howard J. Hochman, Esquire 7695 SW 104" Street, Suite 210 Miami, Florida 33156 (U.S. Mail) Claude B. Arrington Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassce, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity JoAnn Jackson, Medicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the ve day of wor \__, 2003. Chace Tha so Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA ns, DIVISION OF ADMINISTRATIVE HEARINGS S P&D PHARMACY DISCOUNT, INC. d/b/a ISABEL PHARMACY, Petitioner, VS. CASE NO. 02-4299 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and P&D Pharmacy Discount, Inc. d/b/a Isabel Pharmacy (“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 resolving the disputes between them and avoiding the costs and burdens of further litigation. Neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 105762600 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated April 12, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), Office of the Inspector General, indicated that certain claims, in whole or in part, were not covered by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $25,951.40. In response to the audit letter dated April 12, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-1967. P&D Pharmacy Discount, Inc. d/b/a Isabel Pharmacy Settlement Agreement 4. Subsequent to the original audit that took place in this matter and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the overpayment was adjusted to $20,151.65. The PROVIDER again submitted additional documentation for review and the overpayment was adjusted to $9,490.35. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) (2) (3) (4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of nine thousand four hundred ninety dollars and thirty-five cents ($9,490.35) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-4299). AHCA retains the right to perform a 6-month follow-up review. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.I. 00-1709- 000-3. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. P&D Pharmacy Discount, Inc. d/b/a Isabel Pharmacy Settlement Agreement 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. 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. 8. AHCA reserves 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. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. 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. 12. 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. 13. 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. P&D Pharmacy Discount, Inc. d/b/a isabel Pharmacy Settlement Agreement 14. 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 contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 15. 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 proceeding and any and all issues raised herein. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. 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. 17, 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 shall not affect any other provision of this Agreement. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. P&D Pharmacy Discount, Inc. d/b/a Isabel Pharmacy Settlement Agreement 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. P&D PHARMACY DISCOUNT, INC. d/b/a ISABEL PHARMACY Dated: 4) 2f — _, 2003 py: dose Eniiave ‘aver (Print name) ITs: (ES hut, AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Afoelc Dated: bert 2P_,2003 Rufus Néble Inspector General Let bed. é Dated: Spade. AU, 2003 hristian Dated: f- / 7 ___, 2003 Clark Assistant General Counsel JES BUSH, GOVERNOR 099 3400 0013 8445 1006 President D Pharmacy Discount, Inc. d/b/a Isabel Pharmacy 2360 West 68° Streec Hialeah, Florida 33016 RE: FINAL AGENCY AUDIT REPORT C.I. No. 00-170S-000-3/H/JIDI Dear. Ms. Delgado: a on-site audit of your vhar adoon July 21, 2000. The audit period was = 98, through rough the Agency May 26, 2000. The Floride Me for Health Care Administration ae hat you have been overpaid $25,951.40 ine tion c iaims submitted to Medicaid during the audit period. This conciusion is supported by the audit results. cor This review and < the provisions of tc Chapter 59G, Florida Adz for Medicaid reimbursement, applicable statutes, rules, t , steécements of Medicaid policy, ea jaws and regulations Medicaid cannot properly pay for cleims that Go not meet Mecicaid requirements. When a provider receives payment in violation of these provisions, those funds must be repaid REVIEW DETERMINATIONS € universe of cléims al overpay proven v Visis AHCA Onitne at Mahan Drive © Mari Stop = 6 Os wick fdine. state flus Tallahassee, FL Phammacy @ @ bob célculaztions, @ summary of a = n ached are the ovezpaymen ° ec Listing of Giscrepancies no er Lota discrepancies, and an item he review of the random sampie. If you accept or concur with these Zindings, please send your check in the amount of $25,951.40, for the identified overpayment, made payabie to the Florida Agency for Health Care Administration, to: Agency for Medicaid Acc Post Office Tallahassee, (Note: The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) To ensure proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487-4298. You have the right to request a formal or informal hearing pursuant to section 120.569, F.S. iia petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, F.A.C. Please note that rule sect: 28-106.201(2), F.A.C., specifies that the petition shall cont a@ concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of receipt of this letter. Failure to timely request a hearing shail be ceemed @ waiver of your right to a hearing. It is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: Mr. Charles G. Ginn, Chie= Medicaid Program Integzi Office of the Inspector Te: a Do not send requests or petitions to any other address. zi hearing request is not received witnin 21 days from the date of receipt of this letter, the to such hearing is waived, and repayment of the above-stiptlea overpeyment wiil be due and pevable at the end of that 21-day period. Isabel Pharmacy T ) @ rage 2 Any questions that you may have this matter should be Girecrec to; Ms. JoAnn D. 3 Pharmacist, cy for Health Care Administrati 3 i Program integr 1 cei the Inspector Generel, 27 ve, Mail Stop # 6, Tallahassee, Florida 32308-5403, “Stebnone number (850) 922- 4374. D. Kenneth Yon Program Administrator Mecicaid Program Integrity DKY/3daj Attachments cc:1 Medicaid Program Integrity Administrative Section Medicaid Accounts Receivable, At on: Willie Bivens Heritage Information Systems, Inc.’ , Medicaid Program Development, Pharmacy Services Area Medicaid Office C:\HeritageAudits\isabelPharmAAL

Docket for Case No: 02-004299MPI