STATE OF FLORIDA ; 2: AGENCY FOR HEALTH CARE ADMINISTRATION 4 nx Vier. 2/ Mitre ge Hee Ray, AINE S five DELTONA FOUNTAINS MEDICAL CLINIC, P.A., Petitioner, “Pp (Y iL v. DOAH CASE NO. 02-4799MPI AHCA Provider No. 377330200 STATE OF FLORIDA, Audit No. C.J. 98-0228-000 AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-03-0140-S-MDO ADMINISTRATION, 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 22% day of _F@Grnsv¥_, 2003, in Tallahassee, Florida. Jy eof ; Cho. add Le ° A Rhonda-M. Medows, 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: Gregory A. Charies, Esquire Post Office Box 2310 Winter Park, Florida 32790-2310 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 Timothy Byrnes, Bureau Chief of MPI Agency for Health Care Administration 2002 Old St. Augustine Road, Bldg. D Tallahassee, Florida 32301 Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY 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 RS day of , 2003. Chace 7 hows 6 € Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 ive) te pre hickD STATE OF FLORIDA 3 £ AGENCY FOR HEALTH CARE ADMINISTRATION £B 27 PH Ja; 2] u f yi ik DELTONA FOUNTAINS MEDICAL AQ Mh 4 i ar CLINIC, P.A., HEA Fes ave, AG Petitioner, v. DOAH CASE NO. 02-4799MPI AHCA Provider No. 377330200 STATE OF FLORIDA, Audit No. C.I, 98-0228-000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, (“AHCA” or “the Agency”), and DELTONA FOUNTAINS MEDICAL CLINIC, P.A., (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Settlement Agreement (the “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, with provider number 3773302-00. 3. In its final agency audit report dated October 17, 2002, AHCA notified PROVIDER that a review of Medicaid claims, performed by Medicaid Program Integrity (MPD), indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $82,331.93. In response to the final agency audit report, PROVIDER filed a petition for a formal administrative hearing. ~S ib 4. The matter was referred to the Division of Administrative Hearings (DOAH) and assigned DOAH Case No. 02-4799MPI. Subsequently, AHCA performed a review of additional documentation submitted by PROVIDER to AHCA related to the disputed claims and adjusted the overpayment to $80,984.64. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) (b) (c) AHCA agrees to accept the Payment set forth herein in settlement of the overpayment issues arising from the MPI review, and the issue of liability for all costs or expenses the Agency could assert entitlement to as provided by law. PROVIDER agrees to make a single payment. Within thirty (30) days of , receipt of the Agency for Health Care Administration Final Order incorporating by reference this Agreement in the total sum of EIGHTY THOUSAND NINE HUNDRED EIGHTY-FOUR DOLLARS AND SIXTY-FOUR CENTS ($80,984.64) (the “Payment”), The Payment shall be made by check payable and remitted to: Agency for Health Care Administration Attn. Medicaid Accounts Receivable P. O. Box 13749 Tallahassee, FL 32317-3749 in full and complete settlement of all claims in the audit referenced as C.I. 98-0228-000. The Payment shall clearly indicate that it is made pursuant to the Agreement and shall reference Audit C.I. 98-0228- 000. (d) (e) ( (g) The Payment will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.L. 98-0228-000. PROVIDER is responsible for ensuring timely delivery of the Payment set forth herein. Furthermore, failure to timely make the Payment will render the balance due and payable immediately, with statutory interest, and interest will continue to accrue until the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by any legal means. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which were the subject of the audit in this case. PROVIDER will cooperate in a comprehensive follow-up review within 6 months of the date of the Final Order in the cause to ensure that PROVIDER is billing Medicaid correctly. PROVIDER agrees that failure to make the Payment 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. 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. This Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. The parties agree to bear their own attomey’s fees and costs, if any, and all investigative costs in this matter are borne by the Agency. 10. 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. 11. 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. 12. 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. 13, 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. 14. 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 that adopts the terms of this 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. 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 affect any other provision of this Agreement. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PROVIDER: DELTONA FOUNTAINS MEDICAL oo IC, Pia \ a \, as Cu 4 ~ W ' Dated: —+—--— at , 2003 N c -) . , nN By: amele Ve ato \ Ne, \\ (print name above) Its: Qyecdvea\ SeoN\ot (print title above) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 / / hen MLM E. Dated: aia , 2003 RUFUS NOBLE Inspector General “sf \ “ yet ene ad fox. Dated: VALDA CLARK CHRISTIAN General Counsel, ; Ke ep fem fe yo fio VU j Dated: “SUSAN Cc FELKER-LITTLE Assistant General Counsel » 2003 Za ~

Docket for Case No: 02-004799MPI