STATE OF FLORIDA BTS se DIVISION OF ADMINISTRATIVE HEARINGS = ; JRM PHARMACY, INC. d/b/a - ne SUPER DRUGS PHARMACY, cn, yt, ns “, “ys y Petitioner, TW ; cles 2 CASE NO. 03-0313MPI on “Pardihon Ue dwig ©3-059-S MI oO vs. AGENCY FOR HEALTH CARE 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 _/ 7 day of _-JuW2__, 2003, in Tallahassee, Florida. Ntbe 4 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Anthony C. Vitale, Esquire 799 Brickell Avenue, Suite 700 Miami, Florida 33131 (U.S. Mail) John Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Kathryn Holland, 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 1G day t of Lie , 2003. . Chaves ie upon ye 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 DIVISION OF ADMINISTRATIVE HEARINGS JRM PHARMACY, INC. d/b/a SUPER DRUGS PHARMACY, Petitioner, vs. CASE NO. 03-0313MPI AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “the Agency”), and JRM Pharmacy, Inc. d/b/a Super Drugs 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 102451500 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated May 21, 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 $234,416.42. JRM Pharmacy, Inc. d/o/a Super Drugs Pharmacy Settlement Agreement In response to the audit letter dated May 21, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 03- 0313MPI. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) (2) 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 the first installment to repay two hundred thirty-four thousand four hundred sixteen dollars and forty- two cents ($234,416.42). PROVIDER will pay a lump sum payment of one hundred thirty thousand dollars ($130,000.00) and the remainder of one hundred four thousand four hundred sixteen dollars and forty two cents ($104,416.42) plus 10% interest per year to be made in eighteen (18) equal monthly payments, beginning the first day of the month following the lump sum payment, in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 03-0313MPI. JRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Settlement Agreement (3) 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.J. 99-0514-000-3. (4) 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. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 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 claims. 7. 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees and costs, if any. JRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Settlement Agreement 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 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. 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. JRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Settlement Agreement 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 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. 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. JRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Settlement Agreement 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. JRM PHARMACY, INC. d/b/a SUPER DRUGS PHARMACY oa, , 2003 BY: “£2 GeV OE CBR OE. (Print name) P mn Roe _ ITS: 4 ES ae CVV I FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Mle Dated: __ for / 7 _, 2003 Rufus |Noble Inspector General —s~ ys wt “} ae Sf pe a Had Za MA Ht. Valda Christian General Counsel With. 7| “C— Dated: Ke 4 , 2003 L. William Porter II Assistant General Counsel Dated: bevy Je , 2003 ~ STATE OF FLORIDA ZGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR May 21, 2001 “ie CERTIFIED MAIL - RETURN RECEIPT NO- 7000 1670 0009 9415 4221 Provider No.1024515 00 License No. PHO012495 Arquimides Perez, President ; RECEIV FE D ORM Pharmacy, Inc. d/b/a Super Drugs Pharmacy 5512 S.w. 8° Street Coral Cabies, Florida 33134 JUN 07 200! RE: FINAL AGENCY AUDIT REPORT MEDICAID PROGRAM C.I. No. 99-0514-000-3/KNH GRITY Dear Mr. Perez: ompleted a review of your paid Medicaid Program Integrity has ¢ rvice from May 13, 1998, through Medicaid claims with dates of se November 23, 1999. We have also reviewed your product purchase/ acquisition documentation received on February 22, 2000, from Mr. Rod Presnell, R.Ph. and the McKesson Drug Company report received on February 6, 2001, from Mr. Thomas Keen. You have failed to provide adequate documentation to the effect that the available quantity of certain drugs of given strength was as great as the quantity of those drugs billed to and reimbursed by Medicaid. You are hereby notified that we have determined that IRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy was overpaid $234,416.42 for claims that in whole or in part are not covered by Medicaid. The total amount due is $234,416.42. The above action and your right of appeal are discussed below. er Agreement states that the provider agrees he Florida Medicaid program under the terms and conditions specified in the provider agreement. This includes, but is not limited to, complying with federal and state laws, regulations, rules, Medicaid handbooks and policies. The Medicaid Provid to participate int (F.S.), provides that a4 Section 409.913(7), Florida Statutes ation and submission of a provider is responsible for the prepar claim that is true and accurate and is for goods and services that are provided in accordance with applicable provisions of all Medicaid rules, regulations, handbooks, policies, federal, state, and local laws. en Visit AHCA Online at warn fdhe. stare fl us 2727 Mahan Drive © Mail Stop #6 Tallahassee, FL 32308 Arquimides Perez, | GRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Page 2 F.S., requires a Medicaid provider to retain medical, professional, financial, and business records pertaining to goods and services furnished to a Medicaid recipient for @ period of five years after the date of furnishing the goods and services. you submit invoices from your suppliers to lability of drugs that you billed to fully substantiated such availability. Section 409.913(8), We have required that substantiate the avai Medicaid. You have not F.S., states in part that the Agency may Section 409.913(10), medically unnecessary, Or require repayment for inappropriate, excessive goods or services. Section 409.913(14)(n), F.S., states that: “The agency may seek any remedy provided by law, including, but not limited to, the remedies provided in subsections (12) and (15) and s. 812.035, if:” x ek * “(n) The provider fails to demonstrate that it had available during a specific audit or review period sufficient quantities of goods, or sufficient time in the case of services, to support the provider’s billings to the Medicaid program;” Billing Medicaid for drugs that have not been demonstrated as available for dispensing is a violation of Medicaid laws and ~ regulations and has resulted in the finding that you have been overpaid by the Medicaid program. The overpayment identified in the summary sheet attachment is with regard only to the 16 drugs listed and comprehends only the period audited, namely May 13, 1998, through November 23, 1999. A printout identifying all relevant claims involved in the overpayment and a copy cf the drug purchase/acquisition review are attached. alculation is based upon the assumption that emonstrated as available during the period was exclusively dispensed to Medicaid recipients; this is undoubtedly not the case and the assumption serves to reduce the amount of the calculated overpayment. Medicaid payments that have been substantiated by documented inventory are assumed to be valid; and payments in excess of that amount are regarded to | RECEIVED JUN 07 2001 MEDICAID PROGRAM INTEGRITY. The overpayment Cc all stock that you have d Arquimides Perez, @..icen: @. JRM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Page 3 as shown in the summary sheet attachment, we have time that you have been overpaid by the Medicaid program in the amount of $234,416.42. If additional overpayments are found subsequently, you will be notified. If you accept or concur with these findings, please send your check in the amount of $234,416.42, for the identified overpayment, made payable to the Florida Agency for Health Care Administration, to: Accordingly, determined at this Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (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. Ifa petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, Florida Administrative Code (F.A.C.). Please note that rule section 28-106.201(2), F.A.C., specifies that the petition shall contain 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 shall be deemed a waiver of your right to a hearing. at a request for an informal hearing or a It is important thi be sent only to the following petition for a formal hearing . RECEIVED Mr. Charles G. Ginn, Chief Medicaid Program Integrity Office of the Inspector General ‘i Agency for Health Care Administration JUN 07 2001 2727 Mahan Drive, Mail Stop # 6 MED Tallahassee, Florida 32308-5403 Tear Do not send requests or petitions to any other address. If a hearing request is not received within 21 days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above-stipulated overpayment will be due and payable at the end of that 21-day period. . @ Arquimides Perez, @ cen ~ RM Pharmacy, Inc. d/b/a Super Drugs Pharmacy Page 4 ding this matter should be t you may have regar Senior Pharmacist, Agency directed to: Ms. Kathryn N. Holland, for Health Care Administration, Medicaid Program Integrity, office of the Inspector General, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone number (850) 922- Any questions tha 4374. Sincerely, D. Kenneth Yon Program Administrator Medicaid Program Integrity DKY/knh Attachments cc: Medicaid Program Integrity Administrative Section Willie Bivens, Medicaid Accounts Receivable Medicaid Program Development Area Medicaid Office Anthony C. Vitale, P.A. 799 Brickell Plaza Suite 700 Miami, Florida 33131 (w/summary overpayment a ” 7 RECEIVED JUN 07 2001 MEDICAID PROGRAM INTEGRITY ttachment ) LoOe/e L/ZO JUN 07 2001 MEDICAID PROGRAM INTEGRITY RECEIVED epglp'res = § LN3SWAVdY3A0 TV1LOL LeLze's98 $ le'6sp'9l 9E'BrE'L9 eStSh 0v0z9 9regssso'l 29°208"e8 z0edd 09129 wid doidig yawejag/ejozews}019 OL eeo'st S798 \'p 8807 6¥6 cEgeezl ly SE6LS'2% 2€0S 9209 Bow tz aeojeulx jorB}owIeSs 00°488' Pt 0S'229'6 seze Gees LLe2vOL08't OS EOS" O9set 8629 %I WD IOH Suyeuique | 90'108'Ze SU6LS'6L 6S1S oZoe t22208Se'9 1z20¢e'2s 6278 €2809 Bwose (IGE L IOH auyeuiqay 9p 669'12 62 p82'9e OZeot oogel 99¢eS260'2 SZ'EBh'8r OLLez €9s09 Swot} Sulpeyeio7 02'Los'e 6E'6E9' 12 esth O2tL QBECEED'E 65°0P1'Se cL28 ‘Seer Bwi00s woAuoryIUe|O 25'2e6'e 62'908'b2 9set 00251 E€LOSOOBS'| 9E'6EL'Le gssZt OLLLb Swot BUIPEZIN 92'406'8 to'sce' le ple OOS}! SBerze/e2 se'gsgz'oC vest osedr Bwoz lOH Sunexon)4 €9°S06 eLeSt' Lb eve 00921 ELescerz € Ov sso'er creel bSOLp Bwoos IDH Upsexoyjodig Z2'p08'L LE°Gp9'%2 Ost Oerrt ZySZEG9S'L 60'OSP' bc ogsst OePor Bwoz Sulpiowe 4 _ LL 8e%'9 so'egz'ze vS6l Ovre SBESOOEZ'E 28°961'rE v6EOL £ES9% Bu9z UNEISBAWIS eerie 88'°6E9'2e 0281 OOLLL Br8z96E0'2 00'2SE'9z 02621 10z02 Bwos IDH BueIuas GS'922' be 6y'9S2 2p Spee 099S 22018S9r'2 P0'ESP'99 S068 zB0St Bu} auldezueiQ SO'BES'2e €r peo'6e BLS8 O0c1t POLEESPO'? BY CLI'eS SiZét OLeEL Bwoot WINIPOS IBUajOIIIQ Ce 6Lt'ey SE'LSE'VEL LULet OvSps eypLSEQSe Bi Les’ zee 25999 osrso Bwioz sozedewo, QL bib iet $ 82 Péel'or $ 18ge OOZEL ZlSpBizee vo'sos'ss $ teed 62520 Swoe a10ze:dosue} BE/EC/L I - BE/EL/S :@2INaS jo sajeg 00 SISPZO} ON Japiacig Aoeuueud s6ruq iadng eyqp ANSWAVdYHSAO AXYVAWNS “oul ‘Aoewieug WHT

Docket for Case No: 03-000313MPI