Petitioner: THE BISCAYNE INSTITUTE
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: CLAUDE B. ARRINGTON
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Oct. 21, 2003
Status: Closed
Recommended Order on Tuesday, June 15, 2004.
Latest Update: Apr. 25, 2008
Summary: Whether Petitioner is entitled under Florida’s workers’ compensation laws to payment for professional services to an injured worker for the billings identified by the three notices of disallowance at issue in this consolidated proceeding.Disallowance of payment for rehabilitation services that were not reasonable or medically necessary should be sustained.
(9-15 04
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION /6E!
THE BISCAYNE INSTITUTE, 1th SEP-9 A $58
Petitioner,
DOAH CASE NOs. 03-1837, -1838, -3890
vs. RENDITION NO. AHCA- 0420 - or QS
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AGENCY FOR HEALTH CARE yt a 6
ADMINISTRATION, : =
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CITY OF HOLLYWOOD AND FLORIDA no
LEAGUE OF CITIES,
Intervenors.
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FINAL ORDER
This cause was referred to the Division of Administrative Hearings and assigned to an
Administrative Law Judge (ALJ) for a formal administrative hearing and the entry of a
Recommended Order. The Recommended Order of June 15, 2004, is attached to this Final Order
and incorporated herein by reference.
RULING ON EXCEPTIONS
The petitioner filed exceptions to findings of fact 3, 4, 6, 7, 8, 9, 10, 28-31 collectively,
and 32-33 collectively. The petitioner also filed one collective exception to conclusions of law
36-38. The exceptions are denied for the reasons set forth below.
Each specific exception to each of the above-listed finding of fact simply restates
evidence already presented at the hearing, and does nothing more than dispute the ALJ’s
evidentiary findings; they do not establish an absence of competent substantial evidence.__See
generally Section 120.57(1)(1), Fla. Stat. (providing in pertinent part that “(t)he agency may not
reject or modify the findings of fact unless the agency first determines from a review of the
entire record...that the findings of fact were not based upon competent substantial evidence.”),
Heifetz v. Department of Bus. Regulation, 475 So.2d 1277, 1281 (Fla. 1985) (holding that an
agency “may not reject the hearing officer’s finding (of fact) unless there is no competent,
substantial evidence from which the finding could reasonably be inferred.”). The record shows
that the ALJ’s findings of fact are supported by competent substantial evidence. Therefore the
petitioner’s exceptions to the findings of fact are denied.
Section 120.57(1)(1) provides in pertinent part:
The agency may adopt the recommended order as the final order of the agency.
The agency in its final order may reject or modify the conclusions of law over
which it has substantive jurisdiction and interpretation of administrative rules over
which it has substantive jurisdiction. When rejecting or modifying such
conclusion of law or interpretation of administrative rule, the agency must state
with particularity its reasons for rejecting or modifying such conclusion of law or
interpretation of administrative rule and must make a finding that its substituted
conclusion of law or interpretation of administrative rule is as or more reasonable
than that which was rejected or modified.
The conclusions of law to which petitioner excepts, numbers 36 through 38, are verbatim
quotes of Sections 440.13(7), 440.13(1)(u), and 440.13(1)(1), Florida Statutes. The Agency
cannot modify or reject these conclusions; that would amount to amendment of a statute,
authority for which lies with the Legislature. Petitioner’s exception does not implicate the
reasonableness of the conclusions of law. Therefore the petitioner’s exceptions to the
conclusions of law are denied.
FINDINGS OF FACT
The Agency adopts the findings of fact set forth in the Recommended Order.
CONCLUSIONS OF LAW
The Agency adopts the conclusions of law set forth in the Recommended Order.
IT IS THEREFORE ADJUDGED THAT:
The disallowances at issue in these consolidated proceedings are sustained.
DONE and ORDERED in DOAH Case Nos. 03-1837, -1838 and —3890 this Ddaay of
MN , 2004, in Tallahassee, Florida.
ALAN LEVINE, SECRETARY
Agency for Health Care Administration
NOTICE OF RIGHT TO JUDICIAL REVIEW
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO
JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL
NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY, ALONG
WITH THE FILING FEE 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 THE RENDITION OF THE
ORDER TO BE REVIEWED.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been
furnished by U.S. or interoffice mail to the persons named below on this Gq day of
pumo1h. 2004.
FOz Agency Clerk
Agency for Health Care Administration
2727 Mahan Drive, MS #3
Tallahassee, FL 32308
COPIES FURNISHED TO:
William R. Pfeiffer
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, FL 32399-3060
Kim Kellum, Esquire
Agency for Health Care Administration
2727 Mahan Drive, MS #3
Tallahassee, FL 32308
Charles D. Jamieson, Esquire
Ward, Damon, & Posner, P.A.
4420 Beacon Circle
West Palm Beach, FL 33404
Timothy Byrnes
Medicaid Program Integrity
Kelly Benpétt
Medjéaid Program Integrity
John Hoover
Medicaid Finance and Accounting
Docket for Case No: 03-003890
Issue Date |
Proceedings |
Apr. 25, 2008 |
Letter to Clerk from G. Indest regarding request for deposition transcript from DOAH file filed.
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Apr. 23, 2008 |
Letter to Clerk from G. Indest regarding request for certified copies filed.
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Jan. 21, 2005 |
THIRD DISTRICT COURT ORDER: Appellant is ordered to file a response within 10 days of the date of this order to the joint motion to transfer appeal.
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Nov. 17, 2004 |
Notice of Firm`s Change of Address (filed by J. Hoffman via facsimile).
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Nov. 05, 2004 |
Corrected Final Order filed.
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Sep. 10, 2004 |
Final Order filed.
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Jul. 01, 2004 |
Exceptions to Recommended Order (filed Petitioner via facsimile).
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Jun. 15, 2004 |
Recommended Order cover letter identifying the hearing record referred to the Agency.
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Jun. 15, 2004 |
Recommended Order (hearing held March 15-18, 2004). CASE CLOSED.
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Jun. 11, 2004 |
Intervenors` Request for Official Notice (filed via facsimile).
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Jun. 02, 2004 |
Order Granting Motion to Accept Late Filing.
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Jun. 01, 2004 |
(Proposed) Recommended Order (filed by S. Stark via facsimile).
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Jun. 01, 2004 |
Motion to Accept Late filing of Revisions to Proposed Recommended Order (filed by S. Stark via facsimile).
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Jun. 01, 2004 |
Letter to S. Stark from M. Spangler regarding Respondent`s/Intervenors` Joint Proposed Recommended Order filed.
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May 28, 2004 |
(Proposed) Recommended Order (filed by S. Stark via facsimile).
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May 28, 2004 |
Respondent`s/Intervenors` Joint Proposed Recommended Order filed.
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May 19, 2004 |
Order Granting Extension of Time to File Proposed Recommended Orders.
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May 18, 2004 |
Petitioners` Unopposed Motion for Extension of Time to Submit Proposed Order (filed in DOAH Case No. 03-3890 via facsimile).
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Apr. 22, 2004 |
Second Amended Certificate of Service for Notice of Attorney`s Retaining Lien filed by G. Indest III.
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Apr. 20, 2004 |
Transcript (Volumes I - VII) filed. |
Apr. 07, 2004 |
Notice of Filing Petitioner`s Composite Exhibits 1 through 37 Marked at the March 15-18, 2004 Administrative Hearing (filed by Petitioner via facsimile).
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Apr. 07, 2004 |
Letter to Judge Arrington from M. Spangler regarding enclosed Intervenors exhibit No. 14 (filed via facsimile).
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Apr. 06, 2004 |
Amended Notice of Status Conference (filed by M. Spangler via facsimile).
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Apr. 02, 2004 |
Letter to Judge Arrington from M. Spangler regarding Petitioner`s exhibit 16 (filed via facsimile).
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Mar. 31, 2004 |
Exhibits (1box) filed. |
Mar. 30, 2004 |
Exhibits (6 boxes) filed. |
Mar. 26, 2004 |
Letter to Judge Arrington from M. Spangler regarding enclosed exhibits filed.
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Mar. 15, 2004 |
CASE STATUS: Hearing Held. |
Mar. 12, 2004 |
Joint Pre-hearing Stipulation (filed via facsimile).
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Mar. 12, 2004 |
Petitioner`s Motion to take Telephonic Testimony at Administrative Hearing Scheduled to Commence March 15, 2004 (filed via facsimile).
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Mar. 12, 2004 |
Intervenors` Motion of Filing and Request for Judicial Notice (1993 Senate Report) filed.
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Mar. 11, 2004 |
Letter to Judge Arrington from D. Riselli regarding the enclosed exhibits to deposition of Merle Barnett filed.
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Mar. 11, 2004 |
Amended Notice of Hearing (hearing set for March 15 through 19, 2004; 10:30 a.m.; Miami, FL; amended as to location).
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Mar. 11, 2004 |
Intervenors` Motion of Filing and Request for Judicial Notice filed.
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Mar. 10, 2004 |
Letter to Judge Arrington from M. Spangler regarding agreed dates for the administrative hearing (filed via facsimile).
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Mar. 08, 2004 |
Notice of Taking Deposition Duces Tecum (M. Barnett) filed via facsimile.
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Mar. 05, 2004 |
Order Granting Petitioners` Motion to Drop Marie DiCowden as a Party Petitioner
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Mar. 03, 2004 |
Re-Notice of Taking Videotaped Deposition for Use at Hearing (Dr. V. Batas) filed via facsimile.
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Mar. 03, 2004 |
Letter to Judge Arrington from M. Spangler regarding the scheduled status conference (filed via facsimile).
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Mar. 01, 2004 |
Notice of Taking Videotaped Deposition for Use at Hearing (Dr. V. Batas) filed via facsimile.
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Mar. 01, 2004 |
Intervenors` Motion for Protective Order (filed via facsimile).
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Mar. 01, 2004 |
Notice of Telephonic Hearing (filed by M. Spangler via facsimile).
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Feb. 26, 2004 |
Exhibits to Intervenors` Motion to Compel Production of Medical Evaluation Records and Reports filed by M. Spangler.
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Feb. 26, 2004 |
Notice of Taking Deposition Duces Tecum of Corporate Respresentative (filed via facsimile).
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Feb. 26, 2004 |
Petitioners` Motion to Drop Marie DiCowden as Party Petitioner (filed via facsimile).
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Feb. 25, 2004 |
Notice of Taking Deposition (A. Raphael, Ph.D) filed via facsimile.
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Feb. 25, 2004 |
Notice of Taking Deposition (K. Fischer, M.D.) filed via facsimile.
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Feb. 25, 2004 |
Intervenors` Motion to Compel Production of Medical Evaluation Records and Reports (filed via facsimile)
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Feb. 24, 2004 |
Deposition (of Jorge Villalba, M.D.) filed.
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Feb. 24, 2004 |
Deposition (of David P. McCraney, M.D.) filed.
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Feb. 24, 2004 |
Deposition (of Fernando G. Miranda, M.D.) filed.
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Feb. 24, 2004 |
Telephonic Deposition (of Gerard Garcia) filed.
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Feb. 24, 2004 |
Deposition (of Thomas G. Hoffman, M.D.) filed.
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Feb. 24, 2004 |
Deposition (of Marie DiCowden) filed.
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Feb. 24, 2004 |
Deposition (of Richard S. Bailyn, M.D.) filed.
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Feb. 24, 2004 |
Intervenors` Notice of Filing Depositions filed.
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Jan. 30, 2004 |
Intervenors` Second Set of Interrogatories to Petitioners (filed via facsimile).
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Jan. 30, 2004 |
Intervenors` Notice of Service of Second Set of Interrogatories to Respondents (filed via facsimile).
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Jan. 30, 2004 |
Intervenors` Fourth Request for Production to Petitioners, Marie A Dicowden, Ph.D., and the Biscayne Institutes (filed via facsimile).
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Dec. 15, 2003 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for March 15 through 19, 2004; 10:30 a.m.; Miami, FL).
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Dec. 11, 2003 |
Intervenors` Response to Petitioners` Motion to Continue (filed via facsimile).
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Dec. 11, 2003 |
Notice of Hearing (filed by S. Stark via facsimile).
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Dec. 09, 2003 |
Petitioners` Motion for Continuance of Final Hearing (filed via facsimile).
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Dec. 05, 2003 |
Intervenors` Third Request for Production to Petitioners, Marie A Dicowden, Ph.D, and the Biscayne Institutes (filed via facsimile).
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Dec. 04, 2003 |
Letter to J. Benoit from M. Spangler regarding served subpoenas (filed via facsimile).
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Dec. 03, 2003 |
Intervenors` Second Request for Production to Petitioners, Marie A Dicowden, Ph.D, and the Biscayne Institutes (filed via facsimile).
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Dec. 03, 2003 |
Notice of Telephonic Hearing (filed by M. Spangler via facsimile).
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Nov. 25, 2003 |
Order Denying Motion for Protective Order.
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Nov. 25, 2003 |
Petitioners` Emergency Motion for Protective Order (filed via facsimile).
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Nov. 17, 2003 |
Amended Notice of Taking Telephonic Deposition Duces Tecum (G. Garcia) filed.
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Nov. 17, 2003 |
Seconde Amended Notice of Taking Deposition Duces Tecum (D. McCraney, M.D.) filed.
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Nov. 17, 2003 |
Notice of Taking Telephonic Deposition Duces Tecum (G. Garcia) filed.
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Nov. 17, 2003 |
Amended Notice of Taking Deposition Duces Tecum (4), (D. McCraney, M.D., T. Hoffman, M.D., R. Bailyn, M.D., and F. Miranda, M.D.) filed.
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Nov. 17, 2003 |
Notice of Taking Deposition Duces Tecum (6), (J. Villalba, M.D., D. McCraney, M.D., T. Hoffman, M.D., R. Bailyn, M.D, F. Miranda, M.D., and M. DiCowden Ph.D) filed.
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Nov. 17, 2003 |
Notice of Service of Intervenors` Supplemental Answers to Petitioners` Expert Interrogatories filed.
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Nov. 13, 2003 |
Intervenors` Motion to Compel Production of Documents and Answers to Interrogatories Propounded on Petitioners (filed via facsimile).
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Nov. 04, 2003 |
Letter to J. Hoffman from M. Spangler regarding the rescheduling of serveral depositions (filed via facsimile).
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Oct. 29, 2003 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for January 5 through 9, 2004; 10:30 a.m.; Miami, FL).
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Oct. 28, 2003 |
Order of Consolidation Case: 03-003890 was added to the consolidated batch.
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Oct. 28, 2003 |
Unilateral Response to Initial Order and Motion to Consolidate (Cases requested 03-3890, 03-1937, and 03-1838) filed via facsimile.
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Oct. 27, 2003 |
Notice of Appearance (filed by S. Stark, Esquire, via facsimile).
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Oct. 23, 2003 |
Notice of Substitution of Counsel and Request for Service (filed by D. Riselli, Esquire, via facsimile).
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Oct. 22, 2003 |
Initial Order.
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Oct. 21, 2003 |
Denial or Request for Reimbursement Dispute Resolution filed.
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Oct. 21, 2003 |
Respondent the Biscayne Institutes`s Petition for Formal Hearing filed.
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Oct. 21, 2003 |
Notice (of Agency referral) filed.
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Orders for Case No: 03-003890