FILED STATE OF FLORIDA NOV 1? 03 AGENCY FOR HEALTH CARE ADMINISTRATION lea CPP. T ONT SLERK QoQ NAVARRO DISCOUNT wt PHARMACY NO. 10, INC., G0 B on eee 2 Petitioner, mm De / BoE F vt anf -close Ze* 2 O vs. CASE NO. 03-1849MPI Bre “os AHCA Provider No, 021553806, 3 CINo.02-0600-000 so AGENCY FOR HEALTH CARE Hadihon No. ABCA OS TG ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement foregoing, this file is CLOSED. Agreement, which is incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the DONE and ORDERED on this the 6 2003, in Tallahassee, Florida. day of Natur Med&wWs, MD, Secretary 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) Michael M. Parrish 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) “RufasNobte, Inspector 41) Agency fi are Administration eroffice 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) dudy TRIN Onsordto~e Blunweal 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 j@ day of hiner, 2003. fo san L SHA Dhwallr y Gee Lealand McCharen,, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA ly & 2D NAVARRO DISCOUNT PHARMACY No.10, Inc. “Y, ae 2 Petitioner, os. & vs. CASE NO. 03-1849MPI AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, (“AHCA” or “the Agency”), and NAVARRO DISCOUNT PHARMACY No. 10, Inc. (“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 avoiding the costs and burdens of litigation. 2. PROVIDER is a Medicaid provider in the State of Florida, with provider number 0215538-00. 3. In its final agency audit report dated April 7, 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 amount of $6,348.80. In response to the final agency audit report, on April 28, 2003 PROVIDER filed a petition for a formal administrative hearing primarily for the reason that some claims in whole or in part were not covered by Medicaid because they were submitted erroneously with the incorrect physician's license number. Navarro Discount Pharmacy No.10, Inc. DOAH Case No. 03-1849MPI Settlement Agreement Page 2 of 5 4. The matter was referred to the Division of Administrative Hearings (DOAH) and assigned DOAH Case No. 03-1849 M.P.I. Subsequently, AHCA agreed to accept the overpayment amount without the statistical extrapolation, which is $130.83. 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 THREE THOUSAND SIX HUNDRED FIFTY-FIVE DOLLARS AND EIGHTY-THREE CENTS ($3,655.83), which constitutes: () Medicaid claims overpayment of $130.83; (2) — Costs of $3,525.00. (c) The payment of $3,655.83 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 all claims in the audit referenced as C.1. No. 02-0600-000/3/H/GED. Payment shall clearly indicate that it is pursuant to a settlement agreement and shall reference Audit C.I. No. C.1. No. 02-0600- 000/3/H/GED. (d) | 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.1. No. 02-0600-000/3/H/GED. (e) | 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 Navarto Discount Pharmacy No.10, Inc. DOAH Case No. 03-1849MPI Settlement Agreement Page 3 of 5 accrue until the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by any legal means. (63) 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. {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 Medicaid provider agreement requires it to comply with state and federal laws, rules and statements of Medicaid policy. PROVIDER further agrees that Medicaid policy requires the correct prescriber license number and the correct patient identification be submitted on the claim to Medicaid. PROVIDER is obligated to submit claims in accordance to these provisions to include submitting the correct prescriber license number and patient identification. Failure to do so is a violation of Florida law and Medicaid policy as referenced in the Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook, and will constitute an Overpayment. 6. 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. 7. This settlement does not constitute an admission of intentional or unintentional wrongdoing, violation of any order, law, Statute, regulation, duty or contract, or error by either party with respect to this case or any other matter. Compliance with this Agreement shall not be construed as an admission by PROVIDER of any liability whatsoever. 8. The parties agree to bear their own attorney’s fees and costs, if any, except as hereinabove stated. 9. 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. Navarro Discount Pharmacy No.10, Inc. DOAH Case No. 03-1849MPI Settlement Agreement Page 4 of 5 10. 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. 11. 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. 12. 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. 13. | PROVIDER expressly waives in this matter its tight 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 tules 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. 14. 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. ‘Navarto Discount Pharmacy No.10, Inc. DOAH Case No. 03-1849MPI Settlement Agreement Page 5 of 5 15. 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. 16. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 17, __ All times stated herein are of the essence of this Agreement. 18. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PROVIDER: Dated: 7 /22— , 2003. ed repyésentative for Navarro Discetint Pharmacy Ng. 10, Inc. je T AMvVAALO , 1 THE AGENCY: Dated: Natmbar le. , 2003. ely MA @ Dated: “As S003, VALDA CLARK CHRISTIAN General Counsel

Docket for Case No: 03-001849MPI