STATE OF FLORIDA cae DIVISION OF ADMINISTRATIVE HEARINGS =" ” en ee - | A 28 ANTONIO TEJERO, M.D., ol CASE NO. 04-0032 MPT 400 #1 Petitioner, AHCA NO. C. I. 02-0151-000 RENDITION NO.: AHCA-04- q vs. ~ QA STATE OF FLORIDA, AGENCY FOR K Cn Ar) HEALTH CARE ADMINISTRATION, SDP s poe SF Respondent. Os 8 = Pe) ___ / Sf FINAL ORDER The parties have resolved all disputed issues and have 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. tt — DONE and ORDERED this 27 ~ day of wMikAbM —_, 2004, in Tallahassee, Leon County, Florida. STATE OF FLORIDA. AGENCY FOR HEALTH CARE ADMINISTRATION Geo : Z por ALAN LEVINE, SECRETARY 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 CENIDSY SSS 1 HEREBY CERTIFY that a true and correct copy of the foregoing Final Order J has been furnished by U.S. or interoffice mail to the persons named below on this * day ocerg Safe? Fad ee ae Cl — F Siate of Florida, Agency for Health Care Administration 2727 Mahan Drive, MS 3 Tallahassee, Florida 32308 (850) 922-5873 OPIES FURNISHED TO: Donald R. Alexander Administrative Law Judge Division of Administrative Hearing 1230 Apalachee Parkway The DeSoto Building Tallahassee, Florida 32399-3060 Jeffries H. Duvall, Esquire Stare of Florida, Agency for Health Care Administration 2727 Mahan Drive, MS 3 Tallahassee, Florida 32308 Dr. Antonio Tejero c/o James M. Barclay Ruden McClosky et al. 215 South Monroe Street. Suite 815 Tallahassee, FL 32301 Timothy Byrnes Medicaid Program Integrity 2002 St Augustine Road Building D Tallahassee. FL 32301 Jean Lombardi Medicaid Finance and Accounting 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 Ny, os xe From: Bennett, Kelly OL, tt Sent: Thursday, August 12, 2004 11:20 AM Gh, " To: Duvall, Jeffries Ce % Cc: Reyes-Rosales, Magda; Ribera, Raquel; Garcia, Adolfo ° Subject: RE: Dr. Antonio Tejero - Audit no. C.1. 02-0151-000." Importance: High PLEASE PRINT THIS EMAIL AND ROUTE WITH THE AGREEMENT AND FINAL ORDER This email is to confirm your settlement authority. We will accept the full FAL amount ($11,354.39) plus some amount toward our costs, to be paid in one lump sum within 30 days of issuance of a final order. We have documented invoices for $675 plus our documented work on the case by MPI investigatory staff. We would like to get $1500 toward costs, however you are authorized to resolve this matter for $12,000 in total ($11,354.39 o/p and $545.61 toward costs) minimially...we would like up to $12,854.39 ($1500 in costs). Please advise the investigator and administrator if this matter is resolved satisfactorily such that they may discontinue any trial preparation. Ad itionally, should this matter not be resolved within one week of this email, please confirm whether the terms set forth above remain acceptable to MPI before entering into an agreement with the provider. I would presume that, should we continue to prepare for a hearing in this matter, review additional records, and/or secure expert witnesses, we will require a portion (or greater portion) of our expenses to be recovered as well. soon Original Message----- From: Duvall, Jeffries Wednesday, August 11, 2004 3:02 PM Sent: To: Bennett, Kelly Subject: Dr. Antonio Tejero - Audit no. C.1. 02-0151-000. Keily, Dr. Tejero has agreed to pay the FAAL amount of $11,354.39. Do you want to include any costs in the settlement figure? This is Cindy Ribera's case in Miami. 1 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS jc ANTONIO TEJERO, M.D., Petitioner, . vs. CASE NO. 04-0032MPI STATE OF FLORIDA, AGENCY FOR JUDGE: Robert E. Meale HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Ofte STATE OF | FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and ANTONIO TEJERO, M_D.., (“PROVIDER”), by and through the undersigned, 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 audit report dated November 17, 2003, 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 overpayment in the amount of $11,354.39. In response to the audit letter dated November 17, 2003, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 04-0032 MPI. The parties have agreed that the amount of $11,354.39, plus $750.00 costs, paid within 30 days of the finalization of this settlement agreement, will be acceptable by the Agency as full payment of audit number C.I. 02-0151-000. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (A) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (B) Within thirty days of receipt of the final order, PROVIDER agrees to make a single payment of Eleven Thousand Three Hundred Fifty- Four Dollars and Thirty-Nine cents plus Seven Hundred Fifty dollars costs, in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 04- 0032 MPI). (C) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the audit referenced as C.I. 02-0151- 000. (D) 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. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 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 amount due under the terms of this agreement from any monies due 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees 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 on behalf of the respective parties. 11. 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. 12. 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 shal] be valid unless a written amendment to the Agreement is completed and properly executed 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 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 it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 14. This 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. 15. To the extent that any provision of this Agreement is prohibited by Jaw 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. 16. | This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 17. All times stated herein are of the essence of this Agreement. 18. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. Dated: Aizu” , 2004 i pated: f . OF , 2004 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 “a Uf ike i Lf Lyfe a Poe y % & p Yi Ai A Dated: by j L ___, 2004 Valda Christian General Counsel hee A LO, a~——__ Dated: IO] » [OY __, 2004 im Kellum Dated: J fo. L , 2004 Chief Medicaid Coun stant General Counsel a? Yr Z Dated: 27 , 2004 James Boyd Inspector General

Docket for Case No: 04-000032MPI