Petitioner: GENE`S PRESCRIPTION SHOP, INC., D/B/A GENE`S PRESCRIPTION SHOP NO. 1
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: CAROLYN S. HOLIFIELD
Agency: Agency for Health Care Administration
Locations: Punta Gorda, Florida
Filed: Jan. 31, 2003
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, February 26, 2003.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
GENE’S PRESCRIPTION SHOP, INC.
d/b/a GENE’S PRESCRIPTION SHOP
NO 1,
Petitioner, C. S : if . Cle a
vs. CASE'NO. 03-0408
“Rad: Non NOANGA ©3-O£L 93-D% NICO
STATE OF FLORIDA,
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.
PONE and ORDERED on this the & day of Apel , 2003,
in Tallahassee, Florida.
\ fr hf 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)
William M. Furlow, Esquire
Katz, Kutter, Haigler, et al
Post Office Box 1877
Tallahassee, Florida 32301-1877
(U.S. Mail)
Arnold H. Pollock
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 Io day
of (a prcl 2003.
CU var teat Ohio
fe 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
GENE’S PRESCRIPTION SHOP, INC.
d/b/a GENE’S PRESCRIPTION SHOP
NO 1,
Petitioner,
vs. CASE NO. 03-0408
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
ee
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and Gene’s Prescription Shop, Inc. d/b/a Gene’s Prescription Shop
No. 1 (“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
104862700 and was a provider during the audit period.
3. In its final agency audit report (final agency action) dated April 13, 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
Gene’s Prescription Shop No. 1
Settlement Agreement
$61,133.88. In response to the audit letter dated April 13, 2001, PROVIDER filed a petition for |
a formal administrative hearing, which was assi gned DOAH Case No. 03-0408.
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 $30,863.61. The PROVIDER submitted additional documentation for review and the
overpayment was adjusted to $2,281.45.
5. In order to resolve this matter without further administrative proceedings,
PROVIDER and the AHCA expressly agree as follows:
(1) | AHCA agrees to accept the payment set forth herein in settlement of the
overpayment issues arising from the MPI review.
(2) Within thirty days of receipt of the final order, PROVIDER agrees to
' ‘make a lump sum payment of two thousand two hundred eighty one
dollars and forty-five cents ($2,281.45).in full and complete settlement of
all claims in the proceedings before the Division of Administrative
Hearings (DOAH Case No. 03-0408). AHCA retains the right to perform
a 6-month follow-up review.
(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.I. 01-0179-
000-3.
Gene's Prescription Shop No. 1
Settlement Agreement
(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.
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.
Gene’s Prescription Shop No. 1
Settlement Agreement
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. .
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.
Gene’s Prescription Shop No. 1
Settlement Agreement
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.
20. This Agreement shall be in full force and effect upon execution by the respective
parties in counterpart.
GENE’S PRESCRIPTION SHOP, INC. d/b/a GENE’S PRESCRIPTION SHOP NO. 1
Dated: 3/0/62 , 2003
La S, Slat
(Print name)
ITs: WL. Ques aa
la
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
Loft ee . 7 Dated: Leper fF _, 2003
Rufus Noble
Inspector General
“ ee
Llole Ct teks CLG ‘ Dated: LLL vA , 2003
eat Clark Christian
General Counsel
We Dated: (B a | Es 2003
L. William Porter II
Assistant General Counsel
Docket for Case No: 03-000408MPI
Issue Date |
Proceedings |
Apr. 11, 2003 |
Final Order filed.
|
Feb. 26, 2003 |
Order Closing File issued. CASE CLOSED.
|
Feb. 25, 2003 |
Notice of Withdrawal of Petition for Formal Proceedings filed by Petitioner.
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Feb. 18, 2003 |
Order of Pre-hearing Instructions issued.
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Feb. 18, 2003 |
Notice of Hearing issued (hearing set for April 9 and 10, 2003; 9:30 a.m.; Punta Gorda, FL).
|
Feb. 13, 2003 |
Joint Response to Initial Order (filed by Respondent via facsimile).
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Feb. 06, 2003 |
Initial Order issued.
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Jan. 31, 2003 |
Final Agency Audit Report filed.
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Jan. 31, 2003 |
Notice of Substitution of Counsel and Request for Service (filed by L. Porter via facsimile).
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Jan. 28, 2003 |
Petition for Formal Administrative Hearing filed.
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Jan. 28, 2003 |
Notice (of Agency referral) filed.
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