STATE OF FLORIDA 02 mo, yoy 16-03 AGENCY FOR HEALTH CARE ADMINISTRATION ie THE PRESCRIPTION SHOP OF MILTON., Petitioner, v. JUDGE: S.F. DEAN AGENCY FOR HEALTH CARE “Perdehon Oy. ANCA -C1y SMDO ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement which is attached and 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 24 dayof Oebrher __, 2003, in Tallahassee, Florida. MedowWs, 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: Paul R. Green Attomey at Law P.O. Box 605 Milton, FL 32572 Roger Matthews, Pharmacist The Prescription Shop of Milton, Inc. 5524 Stewart Street Milton, Florida 32570 Jeffries H. Duvall, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice) Judith E. Hefren, Inspector General Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS #5 Tallahassee, Florida 32308 (Interoffice) Timothy Bysnes Jean Lombardi Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration 2727 Mahan Drive, MS #14 (Interoffice) S.F. Dean, Administrative Law Judge The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Kathryn N. Holland Senior Pharmacist Agency for Health Care Administration Medicaid Program Integrity (Interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the /@2_ day of AC anterh.tsy 2003. Leal: McCharen, Esq GP Asency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA THE PRESCRIPTION SHOP OF MILTON., Petitioner, CASE NO: 03-2301 MPI v. JUDGE: S.F. DEAN AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and PRESCRIPTION SHOP OF MILTON. (“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, and neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its final agency audit report dated April 11, 2001, AHCA notified PROVIDER that 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 $642,884.00. In response to the audit letter dated Apmil 11, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 03-2301 MPL 4. Following the submission of the matter of the overpayment to DOAH for an administrative hearing, the Petitioner submitted additional documentation. Based upon a review of such additional documentation, it has been determined that an actual overpayment of $11,793.93 exists with which the Petitioner agrees. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the 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 days of receipt of the final order, PROVIDER agrees to make a single payment of Eleven Thousand Seven Hundred Ninety Three and 93/100 dollars. All unpaid amounts shall incur interest at the statutory rate as provided in Section 409.913(24), Florida Statutes. | Payment of this amount shall constitute full and complete settlement of the matter now before the Division of Administrative Hearings (DOAH Case No 03-2301 MPI). (C) 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. No. 00-1827-000-3/H/KNH. (D) 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. 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. 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, 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 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 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. 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 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. THE, PRESCRIPTION SHOP OF MILTON. Jy fe a 2 tts} Hews Pritt name) Dated: Avg, 2¢ \ , 2003 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Ll. oe GF Valda Christian General Coungel . Duvall nt General Counsel Judith/E} Hefr Acti spector General ee 1) ee vw Ki im Kellum Chief Medicaid Counsel Dated: (27> 77 _, 2003 Dated: LI LL, , 2003 Dated: Qetbrtser 2QY , 2003 Dated: 10 [ | | , 2003

Docket for Case No: 03-002301MPI