STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, 20y OCT 12 A WO 3b FLAGLER DIAGNOSTIC CENTER, INC., %, Ms, Petitioner, : oi V of . . fe) vs. DOAH No. 02-4424... JUDGE: StuartM. Lerner, 0 . “e AGENCY FOR HEALTH CARE C.1. #99-0876-000 os ADMINISTRATION, Rardrhan NO: ACA 04 O8I5-S MIO Respondent. FINAL ORDER THE PARTIES resolved all 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 __ oe. 2004, in Leon ncy for Health Care Administration Age! County, Tallahassee, Florida. A PARTY WHOIS 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: Lawrence R. Metsch, Esquire Benjamin R. Metsch, Esquire Metsch & Metsch, P.A. 1455 NW 14" Street Miami, FL 33125 Stuart M. Lerner, Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Anthony L. Conticello, Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Tom Amold, Deputy Secretary for Medicaid Agency for Health Care Administration (Interoffice Mail) Lawrence Stivers, Medicaid Program Integrity Agency for Health Care Administration (Interoffice Mail) Jean Lombardi, Office of Finance & Accounting Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing was served to the above named addresses by U.S. Mail or method designated this / Z day of , 2004. ih, ape -z} Conf ler Agency for Health Care Admitiistration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 FAX NO. : Mar. 12 2084 @4:27PM P 3 we, STATE OF FLORIDA : DIVISION OF ADMINISTRATIVE HEARINGS yi FLAGLER DIAGNOSTIC CENTER, INC. 4) Es a Petitioner, ‘Fog +: Vs. ° CASE NO. 02-4424MPI AUDIT NO, C.1. 99-0876-000 est, STATE OF FLORIDA, AGENCY FOR: HEALTH CARE ADMINISTRATION, Yeo tee kets, Ye Respondent. / i ETTLEMENT AGREEMENT es a STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION : (“AHCA” or “the Agency”), and FLAGLER DIAGNOSTIC CENTER, INC. (“PROVIDER”), a by and through the undersigned, hereby stipulate and agree as follows: e : 1. This Agreemem is entezed into between the parties for the purpose of ws a | _-memorializing the resolution to this matter. st 2. PROVIDER is a Medicaid provider in the State of Flonda, having the Medicaid oy Provider No. 375297600. 3 In its Final Agency Audit Report issued on September 16, 2002, bearing C.J. No. Mt 3. 94 . . :08:0876-000 (the "Audit Letter"), AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount ig of $65,512.33. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 02-4424MPI. PROVIDER submitted gdditional documentation, which resulted in an adjusted overpayment of $22,426.47 (the £8°d SB:St peee-TI~ahiw Fax NO. : Mar. 12 2684 @4:@7PM P 4 “adjusted Overpayment’). PROVIDER agrees to pay the entire Adjusted Overpayment, plus $500 in agency costs over a 6 equal monthly payments as set forth below. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from tbe MPI review. (b) PROVIDER agrees to pay to AHCA the entire Adjusted Overpayment amount of $22,426.47, and $500.00 to AHCA, as complete settlement of all claims in this proceeding before the Division of Administrative Hearings. The total payment shall be $22,926.47, and is payable in six equal monthly payments bearing interest at the rate of 10% per month, The first payment shall be due at the Agency 30 days after the entry of the - Final Order. The iemainiag payments shall be due on the same day ofthe following months, ue (c) PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to yh accrue unt] the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by any legal] moans. (d) PROVIDER and AHCA agree that full payment as set forth above wil] resolve and settle this case completely and release all partes from all ; liabilities arising from the findings in the audit referenced as: 99-0876- 000. ’Q'd 9O:9T pe@Qe-TI-adw FAX NOL: Mar. 12 2684 64:08PM PS (e) PROVIDER agrees that it will nor rebill the Medioaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shall be made to: _ AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahasses, Flonda 32317-3749 And payment shall clearly indicate thet it is per a settlement agreement, shall reference the DOAH Case Number, the Provider Number, and the C.I. Number. 6. 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 c)aims. 7, AHCA reserves the right to enforce this Agreement under the laws of the State of Flonda, the Rules of the Medicaid Program, and al! other applicable rules and ff regulations. mz ; ; te 8. The parties agree to bear their own attorncy’s fees and costs, if any. ae 9. The signatorics 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, Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall fumish the actual signed Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel a final hearing, if one is pending, and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. S8'd 98:97 peage-TI—aol Mar. 12 2804 @4:@8PM P 6 10. 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, ll. This Agreement constitutes the entire agreement between PROVIDER and the AHCA, including anyone acting for, associated with or employed by them, conceming all matters and superscdes any prior discussions, agreements or understandings; there are no & : promises, representations or agreements between PROVIDER and the AHCA other than as set i 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. i : 12. This is an Agreement of setdement and compromise, made in recognition that the & ’ parties may have difforent or incorrect understandings, information and contentions, as to facts ai IN and law, and with each party compromising and settling any potential correcmess or * incorrecmess of its understandings, information and contentions as 10 facts and ! aw, So that no misunderstanding or misinformation shall be a ground for resciesion hureus. ee 13. PROVIDER expressly waives in this matter its right to any hearing pursuant to 2 sections 120.569 or 120.57, Florida Stamtes, 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 the Agency should issue a Final Order which is consistent with the terms of this settlement, that adopts this agreement and closes this matter. 14. Provider, does hereby discharge the State of Flonda, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any end every nature whatsoever, ansing out of or in any way related {0 this mafter, C.I. No. 99-0876-000 and 98'd SQ:9T Pp@ae-TT-yoW FAX NO. : Mar. 12 2@@4 04:@BPM P 7 AHCA's actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims ansing out of this agreement, by or on behalf of Facility. 15. 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. 16. 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 affeet any other provision of this Agreement. 17. This Agreement shall inure to the benefit of and be binding on cach party's successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. ate 20. This Agreement shall be in full force and effect upon execution by the respective Parties in counterpart. - PETITIONER: a 2 se Wee Ay ae . x y 3 & FLAGLER DIAGNOSTIC CENTER, INC aren Wire Po Dated: Sp / 1Y , 2004, 4 e a Dated: s/afoo 2004. 2. By, LAWRENCE METSCH, ESQ. 2S Attomey for Petitioner “% eos = esjam. a Ll. We / C14 ‘ if PLACE CORPORATE SEAL ABOVE . : : aad 28:9T p@Qz—-TT-aW FROM : FAX NO. Mar. 12 2084 64:09PM P 8 €@"d TWLOL + €@'d TWLO4 AGENCY FOR HEALTH CARE ADMINISTRATION : 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Sg Dated: 2cP © 2004. J. SD. BOYD Inspector General Dated: Mol 7. , 2004. ome Of? 2004, XNTHONY L. CONTICELLO, ESQ. Assistant General Counsel aon 4. 3 % ayn “at. yp ead 28:97 pa@Qe-T ty

Docket for Case No: 02-004424MPI