FILED nS 18 3a STATE OF FLO _ DIVISION OF A MINISTRATHVE dead 37 P.K.J. CORPORATION d/b/a “YE s i be ee IFA PHARMACY, ia Sid clos DOAH CASE NO: 03-1174 provider no.: 103201100 audit no.: 01-0037-000-3 Petitioner, v. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. On January 8, 2003 the Agency issued its Final Agency Audit Letter, constituting final agency action in this case, demanding $454,648.93 in recoupment of Medicaid overpayments. In due course, the Petitioner, P. K. J. Corporation d/b/a IFA Pharmacy (“Petitioner”) petitioned for a formal hearing. On May 21, 2003, Petitioner filed a Notice of its Withdrawal of its Petition for Formal Hearing and on May 30, 2003 the Division of Administrative Hearings (DOAH) issued an Order Closing File. Therefore, those facts alleged in the final agency audit letter dated January 8, 2003 are hereby deemed admitted, and form the factual basis for the existence of an overpayment owed by Petitioner, in the amount of Pye, = MENA cLerK $454,648.93. That amount is now due and owing, with interest, since the date of assessment, as more fully set forth below. Based on the foregoing, the request for a hearing is dismissed. It is ORDERED and ADJUDGED that Petitioner refund forthwith, the sum of $454,648.93, together with statutory interest as is set forth in §409.913(24)(b), Florida Statutes. DONE and ORDERED on Qusot- 8 , 2003, in Tallahassee, Florida. s, MD, Secretary Agency 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 Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Lawrence R. Metsch, Esquire Metsch & Metsch, P.A. 1455 N.W. 14 Street Miami, Florida 33125 (U.S. Mail) Florence Rivas Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity JoAnn Jackson, Medicaid Program Integrity John Hoover, Finance & Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above-named addressees Chiqui: iw, 2003. Charters ews AoCLealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 on —————— @ @ STATE OF FLORIDA + DIVISION OF ADMINISTRATIVE HEARINGS P.K.J, CORPORATION, d/b/a IFA Pharmacy, Petitioner, V. DOAH CASE NO. 03-1174 PROVIDER NO. 103201100 AUDIT NO. 01-0037-000-3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, : Respondent. oo PETITIONER'S NOTICE OF ITS WITHDRAWAL OF ITS PETITION FOR FORMAL HEARING (Fla. Bar No. 133162) Petitioner P.K.J. Corporation, d/b/a \FA Pharmacy, by its undersigned attorneys, hereby gives notice of its withdrawal, with prejudice, of its petition for formal hearing in the above styled matter. METSCH & METSCH, P.A. Attorneys for Petitioner 1455 N.W. 14” Street Miami, FL.33125 (305) 545-6400 FAX: (307) 545-7246 I FBN 133162 Law OFFICES OF METSCH & METSCH, PA. (age NW 14 STREET. MIAMI, FLORIDA 33125 * TELEPHONE 305-548-6400 * TELECOPIER BOS-SAS°7E245 aa:et TAOZ-Te-/0l4 £B'd WLOL e@ @ CERTIFICATE OF SERVICE telecopied wcll, | hereby certify that a true copy of the foregoing notice was of May, 2003, to: L. William Porter, Il, Esq. Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, M.S. #3 Tallahassee, FL 32308 ENCE R. METSCH Lew OFFICES OF METSCH 5 METSCH, PA + TELEPHONE 305-545-6400 ° TELECOPIER 205-545-7224 aa:et SARe-Tée-s 1455 NW 14 STREET. MIAMI. FLORIOA 33125 ET a FAX COVER SHEET LAWRENCE R. METSCH BENJAMIN R.METSCY METSCH & METSCH, P.A. 1455S NW 14 STREET MIAMI, TLCORIDA 33125 TELEPHONE (305) S45 ~ 6400 TECECOPIER (305) S45 - 7224 Sea ex = ee te FACSIMILE TRANSMITTAL SHEET ou COMPANY eb, os FAX NUMBER: TOTAL NO OF PAGES INCLUDING COVER: JoO- PHONE NUMBER: SENDER’S REFERENCE NUMBER: RE YOUR REFERENCE NUMBER: Yrorcenr Ororreview Opreasecomment OVP.EASE REPLY O PLease RECYCLE NOTES/COMMENTS SO:ST FO0g-Te-.Ndl TO'd FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION RHONDA M. MEDOWS, MD, FAAFP, SECRETARY JEB BUSH, GOVERNOR January 8, 2003 CERTIFIED MAIL — RETURN RECEIPT NO. 7001 0360 0003 8771 3064 Provider No. 1032011 00 License No. PH0013504 Paul Almaguer, Director P.K.J. Corporation d/b/a IFA Pharmacy 441 Northwest 12th Avenue Miami, Florida 33128 In Reply Refer to: FINAL AGENCY AUDIT REPORT C.I. No. 01-0037-000-3/H/JDJ ' ' Dear Mr. Almaguer: Medicaid Program Integrity has completed the review of your paid Medicaid claims for dates of service during the period January 9, 1999, through July 21, 2000. A provisional agency audit _ report, dated February 22, 2002, was sent to you indicating that we had determined you were overpaid $454,648.93. To date, we have not received any documentation from you to dispute our findings. Therefore, we have determined that you were overpaid $454,648.93 for services that in whole or in part are not covered by Medicaid. Pursuant to Section 409.913, Florida Statutes (F.S.), this letter shall serve as notice of the following sanction(s): The provider is subject to a comprehensive follow-up review in six months. In determining the appropriateness of Medicaid payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies, limitations and requirements found in the Medicaid provider handbooks and Florida Statutes, Section 409.913. In applying for Medicaid reimbursement providers are required to follow the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines. claims paid to your provider number do not meet The following is our assessment of why certain detailing the claims affected by this assessment Medicaid requirements. The audit work papers are attached. 2727 Mahan Drive * Mail Stop #6 Visit AHCA online at www fdhe. state fl us Tatlahassee, FL 32308 Paul Almaguer, Director @ P.K.J. Corporation Page 2 REVIEW_DETERMINATION(G) The audit included the review of paid claims with dates of service sample was extended to the population using generally accep methods. The audit period for th This review identified an overpayment 0 a summary of documented discrepancies, an review of the random sample. The audit also included a comparison paid Medicaid claims. The audit July 21, 2000. The drug quantity paid for by Medicaid, in many instances, excee available to dispense to Medicaid recipients. This review i a statistically valid random during the audit period. Th is review was from January dan itemized lis’ $454,648.93. Attached are the overpayment calculations. If you are currently involved in a bankruptcy, you should notify provide them with a copy of this letter. Please advise your attomey information immediately: (1) the date of filing of (3) the court name and the division in which the petition Florida, Tallahassee, Division); and (4) the name, address, ani attorney. If you are not in bankruptcy and you concur with our findi sample taken from the population of e overpayment found in the random ted statistical formulas and 9, 1999, through July 21, 2000. f $1,286.18. Attached are the overpayment calculations, ting of discrepancies noted in the of your lawful documented product acquisitions with your period for this review was from January 9, 1999, through ded the quantity dentified an overpayment of your attomey immediately and that we need the following the bankruptcy petition; (2) the case number; was filed (e.g., Northen District of d telephone number of your ngs, remit by check in the amount of $454,648.93. The check must be payable to the Florida Agency for Health Care Administration. Questions regarding payment should be di Receivable, (850) 488-5869. To audit number (beginning with C.1.) are shown on your chec ensure proper credit, Agency for Health Care Administration ‘ Medicaid Accoun P.O. Box 13749 ts Receivable Tallahassee, Florida 323 17-3749 If payment is not received, may withhold Medicaid payments in accordance wit F.S. Furthermore, pursuant to or enter into and abide by the terms of any repayment sched result in termination from the Medicaid Program. Question directed to Medicaid Accounts Receivable, (850) 488-5869. You have the right to request a formal or inf request for a formal hearing is m 106.201, Florida Administrative an informal hearing is made, the 106.301, F.A.C. Additionally, you are hereby in the Agency within twenty-one the petition must be received by ade, the peti ormal hearing pursuant t tion must be made in compliance with Section 28- rected to Medicaid Accounts be certain your provider number and the k. Please mail to: or arranged for, within 30 days of receipt of this letter, the Agency h the provisions of Chapter 409.913(26), Sections 409.913(24) and 409.913(14), F.S., failure to pay in full, ule set forth by the Agency may s regarding payment should be o Section 120.569, F.S. Ifa Code (F.A.C.) and mediation may be available, If a request for petition must be made in comp formed that if a request for a hearing is made, liance with rule section 28- (21) days of receipt of this letter. Paul Almaguer, Director @ . @ P.K.J. Corporation Page 3" For more information regarding your hearing and mediation rights, please see the attached Notice of Hearing and Mediation Rights. Senior Pharmacist, Agency for Health Office of Inspector General, 2727 8-5403, telephone (850) 922-4374. Questions should be directed to: JoAnn D. Jackson, Care Administration, Medicaid Program Integrity, Mahan Drive, Mail Stop #6, Tallahassee, Florida 3230 Sincerely, D. Kenneth Yon ABCA Administrator Attachments cc: JoAnn D. Jackson, R.Ph. Medicaid Accounts Receivable Medicaid Program Integrity Chief Craig A. Brand, Esquire Paul Almaguer, Directo @ P.K.J. Corporation ; Page 4 NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the right to request an administrative hearing pursuant to Sections 120,569 and 120.57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Agency Action Report (hereinafter FAAR), you may request a formal administrative hearing pursuant to Section 120.57(1), Florida Statutes. If you do not dispute the facts stated in the FAAR, but believe ' there are additional reasons to grant the relief you seek, you may request an informal administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section 120.573, Florida Statutes, mediation may be available if-you have chosen a formal administrative hearing, as discussed more fully below. 7 The written request for an administrative hearing must conform to the requirements of either Rule 28-106.201(2) or Rule 28-106.301(2), Florida Administrative Code, and must be received by the Assistant Bureau Chief by 5:00 P.M. no later than 21 days after you received the FAAR. The address for filing the written request for an administrative hearing is: Assistant Bureau Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 The request must be legible, on 8 4 by 11-inch white paper, and contain: ‘1, Your name} address, telephone number, any Agency identifying number on the FAAR, if known, and name, address, and telephone number of your representative, if any; 2. An explanation of how your substantial interests will be affected by the action described ‘ in the FAAR; A statement of when and how you received the FAAR; For a request for formal hearing, a statement of all disputed issues of material fact; For a request for formal hearing, a concise statement of the ultimate facts alleged, as well as the rules and statutes which entitle you to relief; For a request for formal hearing, whether’you request mediation, if it is available; For a request for informal hearing, what basis support an adjustment to the amount owed to the Agency; and 8. A demand for relief. ND WA A formal hearing will be held if there are disputed issues of material fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a neutral third party to assist the parties in a legal or administrative proceeding to reach a settlement of their case. If you and the Agency agree to mediation, it does not mean that you give up the right to a hearing. Rather, you and the Agency will try to settle your case first with mediation. If you request mediation, and the Agency agrees to it, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement. If a mediation agreement is not reached within 10 days following the request for mediation, the matter will proceed without mediation. The mediation must be concluded within 60 days of having entered into the agreement, unless you and the Agency agree to a different time period. The mediation agreement between you and the Agency will include provisions for selecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shared equally by you and the Agency. If a written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set forth in the FAAR shall be conclusive and final.

Docket for Case No: 03-001174MPI