STATE OF FLORIDA \ eet AGENCY FOR HEATH CARE ADMINISTRATION Acency CLERK roy way 1 ATES ASA HOME CARE SERVICES, INC., Petitioner, Perm Closed vs. CASE NO. 03-3960MPI S - vB Audit No. 02-0064-000. ~ “4% AGENCY FOR HEALTH CARE , oe) *, — ADMINISTRATION, woe RENDITION NO.: AHCA-04- €205-S-MDO! ‘- Respondent. cA cm / 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 4 — day of LL, , 2004, in Tallahassee, Florida. . PAY (AP OPE. , Agency for Health Care Administration Tig, 560k 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: Michael P. Gennett Wilson, Suarez, Lopez & Gennett Union Planters Bank Building 2151 Le Jeune Road Mezzanine Coral Gables, Florida 33134-4200 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 Robert E. Meale Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Claix Batbe, Medicaid Program Integrity by U. 2004. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the aboy d addressees S. Mail on this the if day «4 , [J LealaWd McCharén, 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 DIVISION OF ADMINISTRATIVE HEARINGS ASA HOME CARE SERVICES, INC. Petitioner, Case No. 03-3960MPI vs. 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 ASA HOME CARE SERVICES, INC. (“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 of this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, operating under provider number 6506356 00. 3. In its Final Agency Audit Report C.I. No. 02-0064-000 (the "Audit Letter") 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 repayment of the amount of $101,027.85. Page | of 1 ASA Home Care Services, Case No. 03-3960MPI Inc. vs. AHCA Audit No. CI. 02-0064-00 Stipulation and Agreement 4. In response, PROVIDER petitioned for a formal administrative hearing with the Division of Administrative Hearings, Case No. 03-3960MPI. By way of its petition, PROVIDER disputed the MPI determination of an overpayment. 5. After PROVIDER requested a formal hearing, AHCA and PROVIDER discussed a potential miscalculation in the overpayment determination. Based upon the correction to the calculation, AHCA adjusted the amount of the overpayment to $5,971. 93. 6. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) (b) (c) (d) AHCA agrees to accept the payment set forth herein in resolution of the issues arising from the MPI review. Within thirty (30) days of issuance of the Final Order, PROVIDER agrees to make a single payment to AHCA of Five Thousand Nine Hundred Seventy-One and 93/100 Dollars ($5,971.93). AHCA retains the right to perform a 6-month follow-up review. 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 accrue until the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by any legal means. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all Page 2 of 2 ASA Home Care Services, Inc. vs. AHCA Case No. 03-3960MPI Audit No. CL 02-0064-00 Stipulation and Agreement liabilities arising from the findings in the audit referenced as C.I. 02-0064- 000. (e) PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which claims were the subject of the audit in this case. (f) PROVIDER agrees to fully cooperate with any follow up reviews conducted by the Agency. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement and shall reference the C.I. Number and the Provider Number. 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. AHCA reserves the right to enforce this Stipulation and Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. Except as specifically set forth above with regard to AHCA’s investigative costs, the parties agree to bear their own attorney’s fees and other costs, if any. Page 3 of 3 ASA Home Care Services, Inc. vs. AHCA Case No. 03-3960MPI Audit No. C.E 02-0064-00 Stipulation and Agreement 10. 11. 12, 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 agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Settlement Agreement to AHCA; however, a facsimile copy shall be sufficient to enable AHCA to cancel the final 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 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 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 Page 4 of 4 ASA Home Care Services, Inc. vs. AHCA Case No. 03-3960MPI Audit No. C.I. 02-0064-00 Stipulation and Agreement 14, 15. shall be a ground for rescission hereof. This settlement does not constitute an admission of wrongdoing or error by either party with respect 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. 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. The parties hereby discharge one another, and one another's agents, representatives, and attorneys 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, C.I. No. 02-0064-000, 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 5 of 5 _ ASA Home Care Services, Inc. vs. AHCA Case No. 03-3960MPI Audit No. C.1. 02-0064-00 Stipulation and Agreement 16. 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. 17. This Stipulation and 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 in this Stipulation and Agreement. 19. This Stipulation and Agreement shall be in full force and effect upon execution by the respective parties in counterpart. ASA HOME CARE SERVICES, INC. / . Dated: A | [| 2004 BY. {\. Bimendz, WaAnuwshato (Printed Name and Title) , SUAREZ, LOPEZ, AND GENNETT Dated: “Z(t , 2004 Attorneys for ASA Home Care Services, Inc. Page 6 of 6 ASA Home Care Services, Inc. vs. AHCA Case No. 03-3960MPI Audit No. CI. 02-0064-00 Stipulation and Agreement AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #39 Tallahassee, FL 32308-5403 Suing 2 BLY ~¢retitrg Inspector General cy th Mb 7 Dated: VA LE, 2004 VALDA ae CHRI General Counsel Dbna é fut Dated: Fehr vary 23 , 2004 DEBORA E. FRIDIE Assistant General Counsel Page 7 of 7

Docket for Case No: 03-003960MPI