STATE OF FLORIDA Pils AGENCY FOR HEALTH CARE ADMINISTRATION APR 21 03 HEBREW HOME FOR THE AGED OF AHCA MIAMI BEACH, INC. d/b/a DEPARTMEH. Teter K ARCH CREEK NURSING CENTER, Petitioner, : “REM eC bss }. ; re) oe . 5 v. DOAH Case No.: 02-4803MPI %, wre Provider No. 213845 Be: Py uch STATE OF FLORIDA, Audit Period July 31, 19 e ‘ AGENCY FOR HEALTH CARE Engagement No. NHO1- 123% Re dite ny Me AUCA-C uP 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. (i dayof_ Ciact. __, 2003, in Tallahassee, Florida. prbe- Kk lure Rhonda M. Medows, MD, Secretary yrs fetration A PARTY WHO JIS 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: Peter A. Lewis, Esquire Goldsmith, Grout & Lewis, P.A. 307 West Park Avenue, Suite 200 Tallahassee, Florida 32308 Susan Felker-Little, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Jallahassee, Florida 32308-5403 Robert E. Meale Administrative Law Judge The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Lisa Milton 2727 Mahan Drive, Mail Stop #21 Tallahassee, Florida 32308 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 __<|_ day of Gi (Qyr AG , 2003. > t Chrcnc iw iS) CHK. dor Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HEBREW HOME FOR THE AGED OF MIAMI BEACH, INC. d/b/a ARCH CREEK NURSING CENTER, Petitioner, vy. DOAH Case No.: 02-4803MPI Provider No. 213845 STATE OF FLORIDA, Audit Period July 31, 1959 AGENCY FOR HEALTH CARE Engagement No. NH01-122R ADMINISTRATION, Respondent. A / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA or the Agency), and HEBREW HOME FOR THE AGED OF MIAMI BEACH, INC. d/b/a ARCH CREEK NURSING CENTER (PROVIDER), by and through the undersigned, hereby stipulate and agree as fellows; . L This 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, operating as nursing home, (ha was audited by the Agency. 3 The Agency conducted an audit of the PROVIDER'S cost report for the period November 25, 1998 to July 31, 1999. 4, In its Audit Report issued on September 30, 2002, AHCA notified PROVIDER that a review of PROVIDER'S cost report revealed that. in its on’nion, some claime in whole or 1 Us PEI WEE LU POG oeUik Gy Dacuika@ll. 1US Agehiy lafuiei WOUlGU fiw eaeES OL WLC HHA OF MlaMI BEACH, INC. da ARCH CREEK NURSING CENTER v. AHCA July 34, 1999/NHO1-122R SETTLEMENT AGREEMENT Page 2 of? adjustment that ANCA was making to its cost report. In response to the Audit Report, PROVIDER filed a timely petition for administrative hearing, the metter was referred to the Division of Administration Hearings for the assignment of an Administrative Law Judge, and the matter was assigned DOAH Case No, 02-4803MPI. 5. Subsequent to issuance of the Audit Report, AHCA and PROVIDER exchanged documents and discussed adjustments that were at issue, and DCAH relinquished jurisdiction to AHCA for the execution of a settlement agreement by all parties. 6, As a result of the aforementioned exchanges, the parties agree that the Agency's adjustments that were the subject of these proceedings, as they relate to the PROVIDER'S cost report for the audit period of November 25, 1998 to July 31, 1999, shall be changed as follows: a. The decrease in acquisition costs of $16,266 in Capital Additions and Improvement to the Schedule of Fair Rental Value System Data will be removed. bd. The Schedule of Fair Rental Value System Data Capital Additions and Improvement “as reported” section wil! be adjusted to reflect the increase of $1,900,000. 7. In order to resolve this matter without further administrative proceedings, - PROVIDER and AHCA expressly agree that the adjustment resolution, as set forth above, will resolve and settle this case completely. As such, this Agreement constitutes PROVIDER’S withdraws! af PROVIDER'S naritian tae cdminicten tive br cese cll eet odte. d. PAU Vin anu stata Gurier agres tial Ine agency Sua Tecaicwate the per ret.do. ar HHA OF MIAMI BEACH, INC. dit/a ! ARCH CREEK NURSING CENTER v, AHCA July 31, 199929H01-122R SETTLEMENT AGREEMENT Pagedor? diem rate for the time period involved in this matter, and issue a notice of the recalculatior,. Where PROVIDER was overpaid, PROVIDER will remit payment to the Agency in the ful! amount of the cost within thirty (30) days of such notice. Where 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. 9, Payment shal] be made to: AGENCY FOR HEALTH CARE ADMINISTRATION oe, Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 PROVIDER Hebrew Home for the Aged of Miami Beach. Inc. d/b/a Arch Creek Nursing Center 12505 NE 16" Avenue North Miami, FL 33161 Payment shal! clearly indicate that it 's pursuant to a settlement agreement and shall reference the audit period/engagement number (Audit Period: July 31, 1999/Engagement No. NHO1- 12aR} _ 10, PROVIDER agrees that failure to pay any monies due and owing under the terms can 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 HHA OF MIAMI BEACH, INC. dive ARCH CREEK NURSING CENTER v. AHCA Suly 31, 1999/NHO1-122R SETTLEMENT AGREEMENT Page 4 of 7 Il. | 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 and regulations, 12, This Agreement does not constitute an admission of wrongdoing or error by either party with respect to this cass 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. 13. Each party shall bear its own attorneys’ fees and costs, if any. 14. The signatories to this Agreement, acting in 8 representative capacity, represent that they are duly authorized to enter into this Agreement cn behalf of the respective parties. PROVIDER agrees to forward a copy of this Agreement to ANCA with original signatures, and understands that a Final Order may not be issued until the Agreement with original signatures is received by AHCA. 13. 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. 16. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and superseces any prior discussions, agreements or understandings; there are no promises. resresentations or asreements between PROVIDER ard ANCA other than es set forth Hea wala, Ge awa Ua Yider ee Ga Gli PlOVISIOL Subd CS ess Side be @ Wartites GLU GUMIEL 16 HHA OF MIAMI BEACH, INC. d'd/a ARCH CREEK NURSING CENTER vy AHCA July J1, 1999/NHO1-122R SETTLEMENT AGREEMENT Pope $ of 7 the Agreement is completed and properly executed by the parties. 17, — 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 us to facts and Jaw, so that no misunderstanding or misinformetion shall be a ground for rescission hereof. 18. PROVIDER expressly waives in this matter its Tight to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conciusions of law by the Agency; and all further and other proceedings to which it may be entitled by law or tules of the Agency regarding this proceeding and any and all issues raised berein, other than \ : enforcement of this Agreement. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter that is consistent with 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. ‘ 19. 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. 20. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shal] be effective to the extent not 0 prohibited, and such prohitition ' Sheu HO elibes Gay Ula pie Ue ee ae ee HHA OF MIAM! BEACH, INC. dein ARCH CREEX NURSING CENTER v, AHCA July 31, 1999/NHO1 +1 22R SETTLEMENT AGREEMENT Page 6 of 7 21. This Agreement shall inure to the benefit of and be binding on each party’s . successors, assigns, heirs, administrators, representatives and trustees. 22. All times stated herein are of the essence of this Agreement. 23. This Agreement shall be in full force and effect upon ex ecution by the respective parties in counterpart. HEBREW HOME FOR THE AGED OF MIAMI BEACHA INC. ARCH CREE ‘Ac nt Dated: 2 of / , 2003 ee za S/F a “xv Dated: 4 7 <> , 2003 PETER 4. LEWIS, Esquire Goldsmith, Grout & Lewis, P.A. 307 West Park Avenue, Suite 200 Tallahassee, Florida 32308 Attomeys for Petitioner HHA OF MIAMI BEACH, INC. d/b/a ARCH CREEK NURSING CENTER v. AHCA July 31, 1999/NHO1-122R SETTLEMENT AGREEMENT Page 7 of 7 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Bob Sharpe Deputy Secretary, Medicaid fh dy Valda Cl General Counsel usan C. Felker-Little Assistant General Counsel s Dated , 2003 “sy i a hd. wan , 2003 Dated: Mice 1 &, 2003

Docket for Case No: 02-004803MPI