PO he STATE OF FLORIDA ee: a DIVISION OF ADMINISTRATIVE HEARINGS ne Hh R28 AS oe AMERICAN PRESCRIPTION PROVIDERS OF FLORIDA, INC., d/b/a APP PHARMACY Petitioner, CASE NO: 03-1175MPI Vv CL No.: 00-1067-000-3 JUDGE: Van Laningham AGENCY FOR HEALTH CARE Bod S : ADMINISTRATION, =2e = a Sem re Respondent. 295 — rT} set Mate / Bee al re os: AAS, oO FINAL ORDER mo: re) Petitioner and the Agency agreed to remand the case from the Division of Administrative Hearings to pursue settlement. A settlement was reached and an agreement sent to Petitioner for execution. After a considerable length of time passed and after efforts by the Agency, Counsel for Petitioner finally contacted the Agency and stated that the business had been sold and is no longer in existence. Thus, the Petitioner was no longer contesting the identified overpayment, and would not enter into a settlement agreement. As a result the Petitioner’s actions, the Agency for Health Care Administration enters this’ Final Order adopting the January 30, 2003 Final Agency Audit Report findings (C.I. 00-1067-000-3) in their entirety. A true and correct copy of the Final Agency Audit Report is attached and incorporated into this Final Order. The overpayment amount is due together with interest from the date of the Final Agency Audit Report, and the Agency imposes the sanction of a comprehensive follow-up review in six months. The Petitioner is directed to comply with the terms of this Final Order. Based on the foregoing, this file is CLOSED. zi DONE and ORDERED on this the 220 day of _@22%__, 2006, in Tallahassee, Florida. fea F 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: Chris Parella, Anthony C. Vitale, P.A Attomey for Petitioner 799 Brickell Plaza, Suite 700, Miami, FL 33131 Erroll H. Powell Administrative Law Judges- rj... Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399 Anthony L. Conticello, Esquire Agency for Health Care Administration (nteroffice Mail) James D. Boyd, Inspector General Agency for Health Care Administration (Interoffice Mail) Timothy Byrnes, Bureau Chief Medicaid Program Integrity Agency for Health Care Administration (Interoffice Mail) Bureau of Finance and Accounting Agency for Health Care Administration (interoffice Mail) 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 Ze tay of” pict” , 2006. LSS Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 i FLORIDA MEDICAID . Page: ty. - . : 07/22/2002: 11:41:05 . Pharmacy Audit - Fin: fre Pom PTS y inal Report EE um, . Form RPT-3 <: —_ oo 03 _gphodit Daidt 06/05/2000 Audit Time Herigsy, 02/12/1999 - 04/21/2000 Pharmacy: APP PHARMACY Address: Amer. Prescript. Proy Of Fl hijs : . . aiff ity Auditors: Bill . Miami Beach, FL 331390000 Anfiiiis. Biigioms Bo or Provider#: 106583100FL Mea pale O- ITS vi ~. ‘I. Description of Claim Samples & Overall Findings: # of Claims § Paltt to Phey A. Total Utilization During Audit Time Period: 46,910 6,871, 659.66 B. Total Judgmental Sample: SSS C. Discrepant Claims in Judgmental Sample: * - D. Documented Overcharges in Judpmental Sample: .. E. Total Random Sample: . : 250 39,749.21 F. Discrepant Claims in Random Sample: * . 43 4,369.17 G. Documented Overcharges in Random Sample: 43 4,369.17 wa wa H, Random Sample Average Overcharge Amount("G" divided by "E")e 17,47668- 1. Random Sample Universe (“4" minus"B")s-: J. Extrapolated Overcharges ("H" multiplied by "I"): K. Total Calculated Overpayment ("D" plus "/"); L. 46,910 95% One-Sided Lower Confidence Limit of Extrapolated Random Sample 490,440.32 M. Documented Overcharges in Judgemental Sample (Line "D") : 0.00 N. Total Recommended Recoveries: 490,440.32 (Includes 95% One-Sided Lower Confidence Limit of Extrapolated Random Sample Plus Judgmental Findings, if any, from line "M") If. Summary of Actual Discrepancies Documented _ cee Section tV for claim-levei detail) : # Discrepancies Code Discrepancy Description CF Original hard copy prescription casnot be found an file during the audit. ee ERLC The number of refills for a controlled substance billed and paid to the provider exceeds the limits set by the Plan. NDEA Tue hard copy prescription does not reference a DEA number and the DEA number is not documented in the pharmacy's computer, ‘The number of refills billed and paid to the pharmacy exceeds the number authorized by prescriber. Refills are dispensed without documented authorization frorn the prescriber, A pharmacy submits 2 claim fora medication that is differeat from the medication authorized to be dispensed to rhe paticnt, ‘The chemlcai name or dosage form is different than that authorized by the prescriber and the Pharmacy cannot show just cause for the difference, UR WDB ‘The claim for the prescription contains au incorrect prescriber license number and the license number is not documented io the pharmacy's computer. . WPB ‘The patient identified on a bard copy prescription is not the patient identified on the paid WMD claim. PT * Some discrepancies may not call for mouetary recoveries, These ore noted to the pharmacy for educational purposes only. Since some claims have multiple discrepancies, individual claims may be listed twice, therefore may exceed the number of discrepant claims listed in section J, ‘ FLORIDA MEDICAID Page: 2s. " . 07/22/2002: 1141:05 : Pharmacy Audit - Final Report Series: 99-36 a Form RPT-3 Pharmacy: APP PHARMACY ; Provider #: 106583100EL eee OI. Comments / Notes: ‘’ FLORIDA MEDICAID Pages 3° - 07/22/2002: 11:41:06 Pharmacy Audit - Final Report Series: 99 - 36 Fonn RPT-3 —_ Ss rg Pharmacy: APP PHARMACY Provider #: 106583100FL . a een IVb. Discrepancy Listing - Random Sample: Member 1D Rx# cos gry Drug NDC Paid —Discrepansies Overcharges Amount 26135091400 1296578 03/05/1999 30 DEPAKOTE TAB 500MG EC 00074621513 4236 CF 42.56 41328127500 = 1297472 03/04/1999 30 CARDIZEM CD CAP 300MGr24 00088179842 15,90 CF 75.90 81298753400 © 1308236 03/05/1999 60 ZERIT CAP 20MG , 00003196501 228.89 CF 228.89 . 14542881200 = 1312735 : 3/1171999 60 PEPCID TAB 20MG 00006096358 95.17 UR~ 95,17 74093145700 = 1312944 »=—-03/01/1999 23040 SUSTACAL LIQ VANILLA 00087035145 94,08 CF . 94.08 75440009400 1313766 92/25/1999 60 CARDURA TAB 4MG 00049277066 57.93 CF . , 57.93 31200131100 = 1317943 05/03/1999 20 HUMULIN IN} 70/30 00002871501 . 43.19 UR ‘19 81257517200 1329886 02/22/1999. 20 SMZ/TMP DS TAB 800-160 00332213213 5.77 CF 5.77 73318867800 1333332. 03/30/1999 , 30 VERAPAMIL TAB 180MG ER 50732091501 1445 CF 14.45 77245412400 = 1334212 03/23/1999 6 PROCRIT INI LOdOW/ML * 59676031001 646,23 OF 646.23 73492619500 1337407 02/15/1999 90 CLONAZEPAM TAB IMG 00093083301 20.72 CF "20.72 81371744200 = 1343933 04/30/1999 60 ZERIT CAP 40MG 00003196701 vs 247.26 WPB 247,26 81226711300 1344168 05/11/1999 30 SMZ/TMP DS TAB 800-160 00382213213 ‘ 654 CF , 654 81284970900 = 200401 12/01/1999 25 BECONASE AQ SPR 0.042% 00173038879 : , 44.10 UR 44.10 31614781400 = 200683 O9/10/1999 60 FUROSEMIDE TAB 20MG 00781181810. 5.37 UR 3.37 75724421800 200740 o7si2/1999 12000 STERIL WATER SOL IRRIG . 00074713909 190.23 CF 190.23 81284058700 = 201717 osoarige9 30 AMITRIPTYLIN TAB SOMG 00378265001 4.88 CF . 4,88 81328127500 = 202121 05/03/1999 30 PREDNISONE TAB 10MG . 00364046101 : 5.44 CF 5.44 81328127500 © 202124 10/01/1999 240 NEORAL CAP 25MG 00078024615 319.71 CF 319, 7 13850915100 202193 (08/24/1999 -300 CALCI-MLX CAP POWDER 34391002703 32.79 CF 32,79, 76352062700 203049 09/07/1999 480 EPIVIR SOL 10MG/ML , 00173047100 126.87 UR 126.87 76371505400 204243 07/30/1999 180 CLONAZEPAM TAB 0.5MG 00093083210 27.39 NDEA 27.39 19120960200 204726 09/04/1999 30, ROCALTROL CAP 0,5MCG 00004014401 55.04 CF 55.04 81227442900 © 2048748 08/04/1999 120 VASOTEC TAB 20MG_ 00006071482 171.64 CF 171.64 81211497900 204914 96/03/1999 30 REMERON'TAB 30MG 00052010730 65.81 CF 65.81 FLORIDA MEDICAID . . Pharmacy Audit - Final Report es eee : Provider # 106583100FL Pharmacy: APP PHARMACY tt 9/10/1999 30 CLONAZEPAM TAB IMG 00093083301 7.45 ERLC 37427640200 74936094900 75334957800 81130061300 75449301400 81042989900 75213620800 81226711300 81084610200 76371505400 76222528500 76089278300 75856695400 09632124200 74323038500 76599128800 77340329500 81198490100 204933 205231 205268 205318 206047 206304 206592 206795 206820 207181 208585 209732 210619 212920 213050 215997 317103 221920 08/02/1999 30 PROCARDIA XLTAB GOMGCR 00069266066 12/30/1999 30 ACYCLOVIR TAB 800MG 55953094740 06/05/1999 480 NORVIR SOL 80MG/ML 00074194063 06/10/1999 30 DIFLUCAN TAB 100MG 0049342030 01/19/2000 ° 30 FUROSEMIDE TAB 40MG 00781196610 : 07/09/1999 240 CROMOLYN SOD NEB 49502068902 06/18/1999 60 VIDEX POW 250MG 00087661643 06/18/1999 90 ALPRAZOLAM TAB 0.25MG- 59762371901 08/13/1999 60 ALBUTEROL NEB 0.5% 59930151504 10/04/1999 4 VIAGRA TAB 100MG 00069422030 08/28/1999 30 NORVASC TAB 10MG 0065154068 03/03/2000 480 ZIAGEN SOL 20MG/ML 00173066400 09/24/1999 . 120 WELLBUTRIN TAB 75MG 00173017755 03/06/2000 120 PENTOXIFYLLI TAB 400MG ER 00378035701 10/23/1999" 30 ATENOLOL TAB SOMG 00364251302 , 12/03/1999 °8000 SODIUM CHLOR SOL 0,9% IRR 00074713809 02/01/2000 30 SMZ/TMP DS TAB 800-160 00093008905 Total Paid Amount Page: 07/22/2002: 11:41:06 65.71 UR _ 42.27 UR 537.76 UR 190.26 CF 4.94 WDB 49.49 CF 245.77 CF 9.33 CF 33.12 UR 34.19 UR 60.06 CF 174.67 UR 88.44 UR 53.68 UR 5.14 CF 132.23 WMD 6.90 WDB 4,369.17 Total Overcharges 7.45 65.71 42.27 537.76 190.26 4.94 49.49 *245.77 933 33.12 34.19 60.06 74.67 aR.Ad 53.68 514 132.23 6,90 4,369.17 CERTIFIED MAIL AUS. Postal Service - (Domestic Mait Only; No.Insurance Coverage Provided) ‘RECEIPT Postage 771 3044 Cortifiod Fee Return Receipt Fee {Endorsement Flguiree) Restricted Delvary Fea {Endorsement Required) Total Postagy ent 10 Sireot, Apt N 799 Brickell Ol. 030 no03 a City, Stata, Zt 7a SENDER: COMPLETE THIS SECTION m™ Complete tems 1, 2, and 3, Also complete Item 4 tf Restricted Delivery is desired. "at Print your name and address on the ravers t 80 that we can return the card to you. or on the front if space permits, 1. Article Addressed to: American Prescription Providers of Florida, Inc. hla AAP Pharmacy c/o Anthony C, Vitale, Eaq. 799 Brickell Plaza, Sulte 700 C2. No. 00-1067-O1-3/H/IDI ™ Attach this card to the back of the maillpiece, American Prescription Providers of ‘Florida, Inc. d/b/a AAP Pharmacy : c/o Anthony C. Vitale, Esq. wel Flaza, Suite 700 or PO BEEN. C1 No. O0AL067-000-3/H/IDI A. Racelved by {Please Print Clearly) |B. Date of Delivery je 2 Yes YES, enter dolivefy dcidress below: 1 No eff Cl Express Mail © insured Mat 1 c.0,p, 4. Rastrictec Delivery? (Extra Foe) 2. Article Number (Copy fram service Jabal) PS Form 3811, July 1999 7001 O30 0003 8774 3144 Cl Registered O Retum Receipt for Merchandise Domestic Return Receipt 102505-00-M-0952 FLORIDA AGENCY FOR HEALTH CARE AOMINISTRATION Re JEB BUSH, GOVERNO: RHONDA M, MEDOWS, MD, FAAFP, SECRETARY January 30, 2003 CERTIFIED MAIL ~ RETURN RECEIPT NO. 7001 0360 0003 8771 3149 Provider No. 1065831 00 License No. PH0016363 American Prescription Providers of Florida, Inc. d/b/a APP Pharmacy c/o Anthony C. Vitale, Esq. 799 Brickell Plaza, Suite 700 Miami, Florida 33131 In Reply Refer to: AMENDED FINAL AGENCY AUDIT REPORT C.L No. 00-1067-000-3/H/IDJ Dear Provider: Medicaid Program Integrity has amended our final agency audit report, dated April 9, 2001 respecting Medicaid claims for dates of service during the period February 12, 1999. through April 21, 2000. The overpayment is adjusted to $490,440.32 for certain claims'that are not covered by Medicaid. Pursuant to Section 409.913, Florida Statutes (F.S.), this letter shall serve as notice of the folowing 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. . The following is our assessment of why certain claims paid to your provider number do not meet Medicaid requirements. The audit work papers detailing the claims affected by this assessment - are attached. i Mail § 2727 Mahon Drive » Mail Stop #6 Visit AHCA online at www fdhe.stateflus Tallahassee, FL 32308 American Prescription Pro. .ers of Florida, Inc. d/b/a APP Pharmacy Page 2 REVIEW _DETERMINATION(SY The audit included the review of a statistically valid random sample taken from the pcpulation of paid claims with dates of service during the audit period. The overpayment found in the random sample was extended to the population using generally accepted statistical formulas and methods. Attached are the overpayment calculations, a summary of documented discrepancies, and an itemized listing of discrepancies noted in the review of the random sample. . If you are currently involved in a bankruptcy, you should notify your attorney immediately and provide them with a copy of this letter. Please advise your attorney that we need the following information immediately: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division); and (4) the name, address, and telephone number of your attorney. If you are not in bankruptcy and you concur with our findings, remit by check in the amount of _ $490,440.32. The check must be payable to the Florida Agency for Health Care Administration. Questions regarding payment should be directed to Medicaid Accounts Receivable, (850) 488-5869, To ensure proper credit, be certain your provider number and the audit number (beginning with C.1.) are shown on your check. Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32317-3749 If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(26), ¥.S. Furthermore, pursuant to Sections 409.913(24) and 409,913(14), F.S., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may result in termination from the Medicaid Program. Questions regarding payment shou.d be directed to Medicaid Accounts Receivable, (850) 488-5869. You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. Ifa request for a formal hearing is made, the petition must be made in compliance with Section 28- 106.201, Florida Administrative Code (F.A.C.) and mediation may be available. If a request for an informal hearing is made, the petition must be made in compliance with rule section 28- 106.301, F.A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt cf this letter. For more information regarding your hearing and mediation rights, please see the attached Notice of Hearing and Mediation Rights. American Prescription Pro — ers of Florida, Inc. d/b/a APP Pharmacy Page 3 Questions should be directed to: JoAnn D. Jackson, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, Office of Inspector General, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 922-4374. Sincerely, dL) kb D. Kenneth Yon AHCA Administrator Attachment ~ ce: JoAnn D. Jackson Medicaid Accounts Receivable Medicaid Program Integrity Chief Anthony Conticello, AHCA Assistant General Counsel American Prescription Pro. ers of Florida, Inc. d/b/a APP Pharmacy Page 4 NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the rightto 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. 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: 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; An explanation of how your substantial interests will be affected by the action described in the FAAR; . Astatement 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; ms . Fora 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 : A demand for relief. 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 tirne 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. : Ifa 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. 1. Pe ND wAwW Ww

Docket for Case No: 03-001175MPI