FILE AGE AGENCY FOR HEALTH CARE ADMINISTRATISS™ CARE ASM RODOLFO COLLANTE, M.D., CLERK Petitioner, vs. oO CASE NO. 03-2821 MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, JUDGE: Stephen F. Dean Respondent. RENDITION NO.: AHCA-04-Of¢40-S-MDO 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 _// ~~ day of ZEEYS, __, 2004, in Tallahassee, Florida. st a As Moore, Interim Secretary Agency for Health Care Administration STRATION 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: Gregory A. Chaires, Esquire Webster, Chaires & Partners, P.L. Post Office Box 2310 Winter Park, FL 32790-2310 Jeffries H. Duvall, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice) Timothy Byrnes, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS #5 Tallahassee, Florida 32308 (Interoffice) Willie Bivins Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration 2727 Mahan Drive, MS #14 (Inter office) Stephen F. Dean Administrative Law Judge DOAH (Interoffice) » Ana st oat ( ce) CERTIFICATE OF SERVICE 1 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 i day ok F “ GL ; 2004. Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 JAN 21 2004 12:15 HP LASERJET 3200 went ea GUM BOELE Ar LNdeRvEl seu p-4 J > Ne STATE OF FLORIDA DIVISION OF ADMINISTRATIVE BEARINGS RODOLFO COLLANTE, M.D, Petitioner, ve. CASE NO. 03-2821 MP1 AUDIT NO. CL. 01-1696 —O00CM-M/HOT 07/12/00 - 07/31/02 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION CAH ” of “the Agency”), and RODOLFO COLLANTE, MD., (“PROVIDER”), by and through the undessigned, 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 andit report dated Jume 26, 2003, AHCA notified PROVIDER that a review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $52,180.80. In response to the andit letter dated June 26, 2003, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No, 03-2821. The partics have agreed that the amount of $52,180.80, paid within 30 days of the finalization of this settlement agreement, will be acceptable by the Agescy as fall payment of audit number C.L 01-1696-000. 2evl Sve v@6 GQ WSL SOHS WOXS AVPLELL vBo-!e~1 vwint Ga euuy Leris HP LHSERJET 3200 enn cu cuut resis Ar LNDeRue! seuU p.> VY A 4 In onder to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree ag follows: . Q) ACA agrees to accept the payment set forth herein in settlement of the overpayment issucs srising from the MPI review. (2) —- Within thirty days of receipt of the final order, PROVIDER agrees to take a single peyment of Fifty-two Thovsand, One Hundred Righty Dollars and Bighty Cents, in full and complete settlement of all claims in the proceedings before the Division of Adminisurative Hearings (OOAH Case No. 03-2821 MPI). @) PROVIDER and AHCA agree thaf full payment as set forth above will resolve and settle this case completcly and release both parties from all Habilities ariting from the audit referenced 23 CI. 01-1696-000. (4) PROVIDER agrees thet it will not rebill the Medicaid Program in any muamuer for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shal} be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Modicaid Accounts Receivable Post Office Box 13749 Tallahassee, Fhorida 32317-3749 6, 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 emoumt due under the terms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims or to pursue any other remedy Ed ; cevl 378 va6 C WYAL SOHS WOUs WVPLFit Pac-ieZ-| JAN 21 2004 12:15 HP LASERJET 3200 Pp. von eu cuur sola nr Loarttved geuuU p.& VY ; ~~, 2. ABCA revarves the right to enforce this Agreement under the laws of the State of Florids, the Rules of the Medicaid Program, and all other applicable rales and regulations. 8. Tinie settlement does not constitute an admission of wrongdoing or exror by either Party with respect to this case or any other matter, 9. Each party shall bear its own attomcys’ fess and costs, if any. 10. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement an behalf of the respective parties, 11. ‘This Agreement shall be construed in accordance with the provisions of the laws of Florida. Vere for my action arising fran this Agreement shall be in Leon County, Florida. 12. This Agreement constitutes the entire agreernent between PROVIDER and the AECA, including anyone acting for, associated with or employed by them, conceming all matters and supersedes any prior discassions, agreements or understandings; there are no Promigs, representations or agreements hetween PROVIDER and the AHCA other than as et forth herein. No modification or waiver of any provision shall he valid unless a written amendment to the Agreement is completed and propesly exocuted by the parties, 13. 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 conchusions of law by the Agency, and all further and other proceedings to which it may bc entitled by law or rules of the Agency reganding this proceeding and any and all issues raised herein, PROVIDER farther agrees that it shall not challenge or contest suy Fina! Order entered in this matter which is consistent with the terms of this scttlement agreement in any forum now or in the future available fo it, inchuting the right to any administrative proceeding, circuit or federal court action or any appeal, cov! 978 Va6 CG WAL SOHS WONS WStFLL vec-i1Z-L JHN ¢2l ¢4£UUH id:ls HP LHSERJE! JeuUu wind Ge UU 4549 nr LAAeRyE! SeUU p.7 wy WY 4a ‘This Agroement is and shall be deemed jointly drafted end written by all parties 19 ‘ stand shall not be ovostried of intexpceted agaiust the party originating of preparing it KB. To the extent that amy provision of this Agreement is prohibited by Saw for any reason, such provision shall be effective to the extent not so prohibited, and uch prohibition shalt not affect any other provision, of this Agreement. 16. This Agreemem shall inaa 1a the benefit of and be binding on each party's suocessors, assigns, heirs, administrators, representatives and trusteos. 17. _ All fimes stated herein are of the essence of this Agreement. 18. ‘This Agreement shall be in fall force and effect upon execution by the respective . parties in counterpatt. FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 zZzyi Sve ras Q WAL SOHS WONS WSL tL | VeZ-La-1 JHN ¢€) 2UU4 12:15 HP LASERJET 3200 vwnn ev cuuw imi. ne LAgeRwe! acu Pp. oar Dated; — -724#' 7, _, 008 James D. Boyd Tnspector Conerel S'd z2vl SVS PAB CO WSL SOHS WOdS WSL: LL P@Z-1e-t

Docket for Case No: 03-002821MPI