Petitioner: GENTLE CARE PEDIATRICS
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: T. KENT WETHERELL, II
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Apr. 01, 2003
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Tuesday, July 1, 2003.
Latest Update: Dec. 24, 2024
Ls i af
SEP 30 PH 2: \0 STATE OF FLORIDA
03 AGENCY FOR HEALTH CARE ADMINISTRATION
GENTLE'GARE PEDIATRICS,
Petitioner, Tho: ( df
vs. CASE NO. 03-1178MPI
AHCA Provider No. 373201100-00
CI No. 02-0192-000//CM-M/HOT
AGENCY FOR HEALTH CARE
ADMINISTRATION, RENDITION NO.: AHCA-03-623-S-MDO
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 _|]_ day of Joplin ,
2003, in Tallahassee, Florida.
roa ede 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:
Lester J. Perling, Esquire
Broad & Cassel, P.A.
100 North Tampa Street
Suite #3500
Tampa, FL 33602
P.O. Box 3310 (33601-3310)
T. Kent Wetherell, II
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, FL 32399
George Daven Shirejian, Esq.
Agency for Health Care Administration
(Interoffice Mail)
Rufus Noble, Inspector General
Agency for Health Care Administration
(Interoffice Mail)
Art Williams, Medicaid Program Integrity
Agency for Health Care Administration
(Interoffice Mail)
Willie Bivens, 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 theg@oq
day of Gept. , 2003.
DY. Gyo P31 ¢ ne
Lealand McCharen; Agency Clerk
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 922-5873
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
GENTLE CARE PEDIATRICS,
Petitioner,
v. DOAH CASE NO. 03-1178/MPI
AHCA Provider No. 373201100-00
AGENCY FOR HEALTH CARE C.I.No. 02-0192-000// CM-M/HOT
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA’ or “the Agency”), and DR. JESINO BUNYI, M.D. AND DR. JOSEPH
WIRTH, M.D., sole proprietors of Gentle Care ‘Pediatrics (‘PROVIDER’),
including by and through the undersigned, hereby stipulate and agree as
follows:
1. 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, with
provider number 373201100-00.
3. In its final agency audit report dated January 22, 2003 AHCA
notified PROVIDER that a review of Medicaid claims performed by Medicaid
Program Integrity (MPI), indicated that, in its opinion, some claims in whole or
in part were not covered by Medicaid. The Agency sought overpayment in the
dettiement Agreement
Page 2 of 6
amount of $80,213.71. In response to the final agency audit report, on
February 12, 2003 PROVIDER filed a petition for a formal administrative
hearing.
4. The matter was referred to the Division of Administrative Hearings
(DOAH) and assigned DOAH Case No. 03-1178 M.P.I1. Subsequently, AHCA
adjusted the overpayment to $70,000.00.
5. In order to resolve this matter without further administrative
proceedings, PROVIDER and AHCA expressly agree as follows:
(a) AHCA agrees to accept the payment set forth herein in
settlement of the overpayment issues arising from the MPI review.
(b) Within thirty (30) days of receipt of the Agency for Health Care
Administration Final Order incorporating by reference this
Settlement Agreement, PROVIDER agrees to make a _ single
payment in the total sum of SEVENTY ONE THOUSAND
DOLLARS ($71,000.00), which constitutes:
(1) Medicaid claims overpayment of $70,0000.
(2) Investigative Costs of $1,000.00.
(c) The payment of $71,000.00 shall be made payable and
remitted to:
Agency for Health Care Administration
Attn. Medicaid Accounts Receivable
P. O. Box 13749
Tallahassee, FL 32317-3749
in full and complete settlement of ail claims in the audit referenced
as C.I. No. 02-0192-000/CM-M/HOT. Payment shall clearly
indicate that it is pursuant to a settlement agreement and
shall reference Audit C.I. No. No. 02-0192-000/CM-M/HOT.
(d) PROVIDER and AHCA agree that full payment as set forth
above will resolve and settle this case completely and release both
Settlement Agreement
Page 3 of 6
6.
parties from all liabilities arising from the findings in the audit
referenced as C.I. No. 02-0192--000/CM-M/HOT.
(ec) PROVIDER is responsible for ensuring timely delivery of the
payment set forth herein. Furthermore, failure to timely make the
payment will render the balance due and payable immediately,
with statutory interest, and interest will continue to accrue until
the entire balance is paid. AHCA reserves the right to seek
enforcement of this agreement by any legal means.
(f)} PROVIDER agrees that it will not re-bill the Medicaid Program in
any manner for claims that were not covered by Medicaid, which
are the subject of the audit in this case.
(g) PROVIDER will cooperate in a comprehensive follow-up review
within 6 months of the date of the Final Order in the cause to
ensure that PROVIDER is billing Medicaid correctly.
(h} PROVIDER agrees that the individuals responsible for
documenting and/or coding for office visits during the audit period
cited in the final agency audit report dated January 22, 2003 will
obtain at least one hour of training regarding the proper method
for billing, documenting, and coding claims submitted to Florida
Medicaid. Provider shall submit a certificate of completion of
training to the Florida Agency For Health Care Administration,
Medicaid Program Integrity, within 6 months of the effective date of
this agreement. The Provider is responsible for acquiring and
receiving the aforementioned training, and such training may be
acquired through a one-on-one interaction from a properly certified
or accredited consultant.
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 withho!d the total remaining amount
due under the terms of this agreement from any monies due and owing to
PROVIDER for any Medicaid claims.
Settlement Agreement
Page 4 of 6
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. The parties agree to bear their own attorney’s fees and costs, if
any, except as hereinabove stated.
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 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 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.
ROWELL SAB COMIC
Page 5 of 6
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.
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 that is consistent with the terms of this settlement 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
Acting
Settlement Agreement
Page 6 of 6
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.
19. This Agreement shall be in full force and effect upon execution by
the respective parties in counterpart. ~
20. This Agreement recognizes that Dr. Wirth and Bunyi are the sole
proprietors of Gentle Care Pediatrics and are each jointly and severally liable
for the duties, obligations, and responsibilities imposed under this agreement.
PROVIDER:
° Dated: ef fF , 2003.
DR. JOSEPH WIRTH, M.D.
Provider Number 037266800
Ine § < O Dated: 6 // 9 , 2003.
DR. JESINO BUNYIYM.D.
Provider Number 037122000
THE AGENCY:
Dated: _Loptimlnr 2003, 2003.
} Be Judi Hetten
Inspector General
Lh aloe Mid CP Dated: Lye fo , 2003.
VALDA CLARK CHRISTIAN
General Counsel
Docket for Case No: 03-001178MPI
Issue Date |
Proceedings |
Sep. 30, 2003 |
Final Order filed.
|
Jul. 01, 2003 |
Order Closing File. CASE CLOSED.
|
Jun. 27, 2003 |
Motion to Remand Case to the Agency For Health Care Administration (filed by Respondent via facsimile).
|
Jun. 10, 2003 |
Order Granting Continuance (parties to advise status by July 11, 2003).
|
Jun. 09, 2003 |
Joint Motion to Continue (filed via facsimile).
|
Apr. 30, 2003 |
Notice of Service of First Set and Second Set of Interrogatories, Requests for Admissions, & Request for Production of Documents (filed by Respondent via facsimile).
|
Apr. 10, 2003 |
Order of Pre-hearing Instructions issued.
|
Apr. 10, 2003 |
Notice of Hearing issued (hearing set for June 17 and 18, 2003; 9:00 a.m.; Tallahassee, FL).
|
Apr. 09, 2003 |
Joint Response to Initial Order (filed by Respondent via facsimile).
|
Apr. 02, 2003 |
Initial Order issued.
|
Apr. 01, 2003 |
Final Agency Audit Report filed.
|
Apr. 01, 2003 |
Petition for Formal Administrative Hearing filed.
|
Apr. 01, 2003 |
Notice (of Agency referral) filed.
|