STATE OF FLORIDA HEATH: AGENCY FOR HEATH CARE ADMINISTRAT]ON PULMONARY PRESCRIPTION PROVIDERS, INC., Petitioner, Picts vs. CASE NO. 03-3959MPI c.I. NO. 00-1070-000-3 AGENCY FOR HEALTH CARE ADMINISTRATION, RENDITION NO.: AHCA-04-0248-S-MDO Respondent. / 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. . ’ olf DONE AND ORDERED on this the /2 day of LEE, , 2004, in Tallahassee, Florida. ry Pat eted Secretary FO gency for Health Care Administration Case No. 03-3959MPI Pulmonary Prescription Providers, Inc. vs. AHCA Final Order 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: Louise T. Jeroslow, Esq. Law Offices of Louise T. Jeroslow Suite 201 6075 Sunset Drive Miami, Florida 33143 Debora Fridie, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Finance and Accounting Patricia H. Malono Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Ramona Stewart, Medicaid Program Integrity Case No. 03-3959MPI Pulmonary Prescription Providers, Final Order I HEREBY Cl Inc. vs. AHCA CERTIFICATE OF SERVICE foregoing has been furnished to the above named addressees day of by U.S. Mail on 2004. ERTIFY that a true and correct copy of the this the Gia Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 t STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PULMONARY PRESCRIPTION PROVIDERS, INC, Petitioner, Case No.; 03-3959MPI vs. CI. No.: 00-1070-000-3 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, / STIPULATION AND AGREEMENT _ STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and PULMONARY PRESCRIPTION PROVIDERS, INC., | (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Stipulation and Agreement is cntcred into between the partics for the purpose of memorializing the resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its Final Agency Audit Report C.T. No. 00-1070-000-3 (the "Audit Letter”) AHCA notificd PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPJ) 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 $22,507.61. In response, PROVIDER petitioned for a formal administrative hearing, which matter was referred to the Division of Administrative Hearings and given DOAH Case No. 03-3959MPI. During the pendency of the audit and the formal proceedings, PROVIDER reversed some of Page 1 of 7 ‘d O968-0¥%2S0E MOTSOWeL estno] a6€'+O -O G2 ueW : Pulmonary Prescription Providers, Inc. vs, AHCA DOAH Case No. 03-3959MPT C.L 00-1070-000-3 Stipulation and Agreement the claims for Medicaid monies to which PROVIDER was not entitled. The reversed claims resulted in most of those claims no longer being at issue in these proceedings. Additionally PROVIDER submitted documentation for review which was previously unavailable to AHCA, AHCA eval uated the documentation submitted by PROVIDER and adjusted the amount of the final overpayment to $3,961.83. PROVIDER agreed to pay the adjusted overpayment plus some of AHCA’s investigative costs, in the amount of $1,038.17, for a total repayment of $5,000.00. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrecs to accept the payment sct forth herein in settlement of the overpayment issues arising from the MPI review. (b) Within thirty (30) days of receipt of the Final Order, PROVIDER agrees to make a single payment to AHCA of Five Thousand and No/100 Dollars ($5,000.00) to resolve all claims in this proceeding before the Agency for Health Care Administration (C.1. No. 00-1070-000-3). AHCA retains the right to perform a 6-month follow-up review. (c) PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to accruc until the entire balance is paid. AHCA reserves the right to seck enforcement of this agrcement by any legal means. Page 2 of 7 etd OS968-0%2S0e MOTSOWer astnot doesin sn -~ Pulmonary Prescription Providers, Inc. vs. AHCA DOAH Case No. 03-3959MPI C.T. 00-1070-000-3 Stipulation and Agreement (d) PROVIDER and AHLCA agree that full payment as set forth above will resolve and settle this casc completely and release all partics from all liabilities arising from the findings in the audit referenced as C.I. No. 00- 1070-000-3. (e) PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covercd by Medicaid, which are the subject of the audit in this casc. (f) PROVIDER agrccs to fully cooperate with any follow up reviews conducted by the Agency. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Reccivable Post Office Box 13749 Tallahassce, Florida 32317-3749 And payment shall clearly indicate that it is per a scttlement agreement and shall reference the C.1. Number and the Provider Number. 6. PROVIDER agrcces 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 noticc, to withhold the total remaining amount due under the terms of this agrecment from any monics duc and owing to PROVIDER for any Medicaid claims. 7. 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. Page 3 of 7 *d OS68-O%2S0E mMOTSO4er Ssstno] dortto ~O S2 veH ra : Pulmonary Prescription Providers, Inc. vs, AHCA DOAI Case No. 03-3959MPI C.T. 00-1070-000-3 Stipulation and Agreement 9. The partics agree to bear their own attorney’s fees and costs, if any. 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. Furthermore, PROVIDER agrevs that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Stipulation and Agreement to AHCA; however a facsimile copy shall be sufficient to enable AHCA to cancel the final hearing and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. This Agreement shall be construcd in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Lcon County, Florida. This Agrecment constitutes the entire agreement between PROVIDER and the AHCA, including anyone acting for, associated with or employed by them, “ conceming 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 sct forth herein. No modification or waiver of any provision shall be valid unless a written amcndment to the Agreement is complcted and properly executed by the parties. This is a Stipulation and Agreement of compromise, made in recognition that the partics may have different or incorrect understandings, information and contentions, as to facts and law, and with each parly compromising and settling Page 4 of 7 0968-O#%2S0E MOTSOUsr estno] dDeteO bO G2 sew Pulmonary Prescription Providers, Inc. vs. AHCA DOAH Case No. 03-3959MPT . C.£. 00-1070-000-3 Stipulation and Agreement 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 Stipulation and Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other mattcr. However, the partics believe that this mattcr should be resolved because the parties have agrecd to the terms containcd within this Stipulation and Agreement. 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 procccding and any and all issues raised hercin. PROVIDER further agrees that the Agency should issue a Final Order which is consistent with the terms of this scttlcment, 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 attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and cxpenses, of any and every nature whatsoever, arising out of or in any way rclated to this matter C.1. 00-1070-000-3 and AHCA’s actions hercin, 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 agrecment, by or on behalf of Facility. Page 5 of 7 O968-0+%2S0E mo [SsOuef asTnoq dO’i+0 +0 G2 eH Pulmonary Prescription Providers, Ine. vs. AHCA DOAH Case No. 03-3959MPT . CI. 00-1070-000-3 Stipulation and Agreement 15. ‘This Agreement is and shall be deemed jointly drafted and wtitten by all parties to it and shall not be construcd or interpreted against the party originating or preparing it. 16. To the cxtent 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 Stipulation and Agreement shall inurc 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 Stipulation and Agreement. 19. This Stipulation and Agreement shall be in full force and cffcct upon execution by the respective parties in counterpart. PETITIONER PULMONARY PRESCRIPTION PROVIDERS, INC. - (Name and Title) Prrl KAAS Dated: _3[v , 2004 LOUSE T. JEROSLOW, ESQUIRE ' Attomey for the Petitioner Page 6 of 7 0968-O%z2S0e mo[Sedar astnoy dOvieo €O S2 Jew Pulmonary Prescription Providers, Inc. vs. AHCA ” DOAI Case No. 03-3959MPI C.1, 00-1070-000-3 Stipulation and Agreement AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 ‘fallahassee, FL 32308-5403 Dated: BY 0X , 2004 rating Inspector Gencral ; Lf. w, WZ 4 Dated: , 2004 VALDA CLARK CURISTIAN General Counsel i =——. ‘ . ‘ ; A flona zz: Ms tht Dated: hor! © 2006- DEBORA E. FRIDIE Assistant General Counsel Page 7 of 7 ava 0968-0%2S0e mo[sOuap e@sIno7 doviro ¢0 Gz 4eW

Docket for Case No: 03-003959MPI