": a . Tee J FILED AGENCY FOR HEATH CARE ADMINISTRATION NW -b 83 ; ANCA, OCP MENT CLERK SAINT PETERSBURG GENERAL HOSPITAL, . . Petitioner, Mb Coaele, .s st vs. CASE NO. 03-28lemBtr <2 02-0454-000. 5 AGENCY FOR HEALTH CARE —™~ : : fl anca , ADMINISTRATION, EeMdthon Wo, AHGA (OX WES : a Respondent. 7 2, — 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 “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the 30 day of October , 2003, in Tallahassee, Florida. M.D., Secretary rv 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 FEB 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: Mary K. Bennett Saint Petersburg General Hospital 6500 38° Avenue North St. Petersburg, Florida 33710 Debora Fridie, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Fred L. Buckine Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Medicaid Program Integrity Interoffice Mail Finance and Accounting 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 day of ' WZ Lealand McCharen, Es Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION SAINT PETERSBURG GENERAL HOSPITAL Petitioner, CASE NO: 03-2818MPI v. Judge: Fred L. Buckine CI. No. 02-0454-000 STATE OF FLORIDA, AGENCY F ‘OR HEALTH CARE ADMINISTRATION, Respondent. / SE STIPULATION AND AGREEMENT 2A IUN AND AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and ST. PETERSBURG GENERAL HOSPITAL (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Stipulation and Agreement is entered into between the parties for the purpose of memorializing the resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, operating under provider number 0120103 00, 3. In its Final Agency Audit Report, C.I. No. 02-0454-000 (the "Audit Letter") 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 Tepayment of an Overpayment amount in the amount of $3,027.12. In response, PROVIDER petitioned for a formal administrative hearing with the Division of Administrative Hearings, Case No. 03-2818MPL Upon further review of documentation Page 1 of 6 St. Petersburg General Hospital vs. AHCA Case No: 03-2818MPI Audit No. C.l. 02-0454-000 Stipulation and Agreement connected with this case, AHCA determined that the Overpayment was properly adjusted to $1,514.56. Both sides stipulate and agree that PROVIDER has paid in full the adjusted Overpayment amount of $1,514.56, In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrees to accept the payment of $1,514.56, which PROVIDER has paid in full, to resolve the Overpayment issues arising from the MPI review, (c) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as C.I. No. 02-0454-000. (e) 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. (f) PROVIDER agrees to fully cooperate with any follow up reviews conducted by the Agency. The parties agree to bear their own attomey’s fees and other costs, if any, The signatories to this Agreement, acting in a Tepresentative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. F urthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER Page 2 of 6 St. Petersburg General Hospital vs. AHCA Case No: 03-2818MPI Audit No. CL. 02-0454-000 Stipulation and Agreement shall furnish the actual si ‘gned Settlement Agreement to AHCA; however a facsimile copy shall be sufficient to enable AHCA to cancel a hearing scheduled in this case. 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. 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. 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. This settlement does Not constitute an admission of wrongdoing or error by either party with Tespect to this case or any other matter. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this agreement. Page 3 of 6 St. Petersburg General Hospital vs. AHCA Case No: 03-2818MPI Audit No. C.I. 02-0454-000 Stipulation and Agreement 10. 11. PROVIDER expressly waives in this matter its right to any hearing pursuant to §§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 the Agency should issue a Final Order which is consistent with the terms of this settlement, that adopts this agreement and closes this matter. Provider does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter, Case No. 03-2818MPI and AHCA’s actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Provider. This Stipulation and 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. Page 4 of 6 St. Petersburg General Hospital vs. AHCA Case No: 03-2818MPI Audit No. C.I. 02-0454-000 Stipulation and Agreement 13. To the extent that any provision of this Stipulation and 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 Stipulation and Agreement. 14. This Stipulation and Agreement shall inure to the benefit of and be binding on each party’s Successors, assigns, heirs, administrators, Tepresentatives and trustees. 15. All times stated herein are of the essence in this Stipulation and Agreement. 16. This Stipulation and Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PETITIONER Dated: FZ Otlibee » 2003 ST. PETERSBURG GENE Petitioner Shudacle Page 5 of 6 St. Petersburg General Hospital vs. AHCA Case No: 03-2818MPI Audit No. CI. 02-0454-000 Stipulation and Agreement Dated: Octoter 30, , 2003 lon Ll Leal of Dated: “Ger £