STATE OF FLORIDA eae tin” AGENCY FOR HEALTH CARE ADMINISTRATION’ “dy ty, ° \5 : 10s KIB -b P $32. * KYLE E FURBEE, D.C. AHCA No.: 2003007787 ’ DOAH No.: 04-1620 TNL, (formerly) DOAH No.: o3-40eet~ 4 (BMRS ID: 200301 15-001.04 a (s) Petitioner, vs. AGENCY FOR HEALTH CARE ADMINISTRATION, , Respondent FINAL ORDER ’ The Agericy for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement, and being otherwise fully advised in the premises, determines as follows: | The attached Joint Stipulation and Settlement Agreement is approved and adopted as a part of this Final Order and the parties are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED: 1. That the parties hereto are directed to comply with terms of the Joint Stipulation and Settlement Agreement. DONE and ORDERED this A day of August, 2004, in Tallahassee, Leon County, Florida. ¢ f > Alan Levine, Secretary Agency for Health Care Administration AHCA # 2003007787 Page 1 of 2 FURBEE v. AHCA Cb ACK AN BALE Cg fm A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, IN THE DISTRICT COURT OF APPEAL 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 THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies to: THE HON DANIEL MANRAY W JOHN GADD ESQ ADMINISTRATIVE LAW JUDGE SMITH FEDDELER SMITH & MILES PA DIVISION OF ADMIN HEARINGS PO BOX 1089 THE DE SOTO BLDG LAKELAND FL 33802-1089 1230 APALACHEE PKWY TALLAHASSEE FL 32399-3060 ELIZABETH DUDEK JOANNA DANIELS DEPUTY SECRETARY ' ' ASSISTANT GENERAL COUNSEL , AGENCY FOR HEALTH CARE (INTEROFFICE MAIL) ADMINISTRATION 2727 MAHAN DRIVE BLDG #1 MS #9 WENDY ADAMS TALLAHASSEE, FL 32308 (INTEROFFICE MAIL) (INTEROFFICE MAIL) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true copy of the foregoing was sent by US MAIL or other means designated to the persons named above on this__@ Lh day of August, 2004. Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 AHCA # 2003007787 Page 2 of 2 FURBEE v. AHCA es 06/21/04 15:07 FAX gouz- U6 JUN-19-2084 13:57 ‘ ; P.@3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION KYLE E FURBEE, D.C. Petitioner, vs. AHCA No. 2003007787 DOAH No, 04-1620 AGENCY FOR HEALTH (formerly) DOAH No. 03-4069 CARE ADMINISTRATION, Judge Danlel Manry BMRS !D: 200301 15-001.01 Respondent ) ee, JOINT STIPULATION AND SETTLEMENT AGREEMENT Petitioner, Kyle E. Furbee, D.C. (herein after “FURBEE”) by and through the undersigned and the Respondent, Agency for Healthcare Administration, (herein after the “AGENCY’), by and through the undersigned pursuant to Section 120.57(4), Florida Statutes, each individually, a “party”, collectively as “parties,” hereby enter into this Joint Stipulation and Settlement Agreement (‘AGREEMENT’) and agree as follows; ) WHEREAS, Kyle E. Furbee, D.C. is a practitioner of Chiropractic Medicine pursuant to Chapter 460, Florida Statutes; and WHEREAS, the Agency has jurisdiction by virtue of being the Regulatory Authority over FURBEE in relation to matters of medical overutilization as relate to providing authorized medical treatment to injured workers pursuant to Chapter 440, Florida Statutes (2003) and more particularly Section 440.13(8), Florida Statutes (2003); and me WHEREAS, the AGENCY, subsequent to evaluating the information forwarded to - it and pursuant to Fla. Stat. §440.13(8), issued a letter dated September 30, 2003 informing FURBEE there was a finding that FURBEE had engaged in overutilization, yet that no penalty was recommended; and (AHCA No. 2003007787) FURBEE v, AHCA (BMHC ID: 20030115-001.01 (Work. Comp.)) Page 1 of 7 gj UUS 4 UU 06/21-04 15:08 Fax ' P.a4 JUN-18-28@84 15:57 1 WHEREAS, the AGENCY in that same letter dated September 30, 2003 did not i] 1 determine that there was a pattern or practice of overutilization and did not determine that FURBEE had violated Chapter 440, Florida Statutes, or rules adopted by the AGENCY: WHEREAS, under Section 440.13(8)(b), Florida Statutes, the AGENCY may only impose the penalties listed in Section 440.13(8)(b), when the AGENCY has determined either that a provider has engaged ina pattern or practice of overutilization or that a provider has violated Chapter 440, Florida Statutes, or rules adapted by the AGENCY; WHEREAS, FURBEE timely filed, pursuant to Section 120.569, Florida Statutes and Rules 28-106.201, F.A.C., a Petition requesting review, heanng, and appeal of the AGENCY'S decision. Said Petition was filed by W. John Gadd, Esquite under cover ‘ dated October 17, 2003; and WHEREAS, on November 14, 2003 the Employer/Carrier filed a Petition for Leave to Intervene as a Party of Interest; and . WHEREAS, on November 24, 2003, the Agency filed a Response in Opposition to the Employer/Carrier's Petition for Leave to Intervene as a Party of Interest; and WHEREAS, by order entered on November 26, 2003, Judge Danie! Manry denied the Employer/Carrier’s Petition for Leave to Intervene as a Party of Interest; and WHEREAS, on March 14, 2004, FURBEE has provided the AGENCY reports fram DR. GAFFNEY AND DR. KRIPPENDORF; and WHEREAS, the Parties have agreed that a fair efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and {AHCA No. 2003007787) FURBEE v. AHCA (BMHC ID: 20030115-001.01 (Work. Comp.)} Page 2 of 7 06/21/04 15:08 FAX gj UU4/ UU JUN-18-2084 13:57 P.@S . 1 WHEREAS, the Parties have nagotiated and agreed that the best interest of all the Parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the Parties intending to be legally bound, agree as follows: 4. All recitals are true and correct and are expressly incorporated herein. 2. All Parties agree that the "WHEREAS" clauses Incorporated herein are binding findings on the Parties. 3. Upon full execution of this AGREEMENT, FURBEE agrees to a withdrawal of this Request for Forma! Hearing; agrees to walve compliance with the findings of the AGENCY as relatas to the reimbursement opinion to which he may be entitled including but not limited to, an informal proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida . Statutes; and Declaratory and all Writs of Relief in any Court or Quasi-Gourt (DOAK) of competent jurisdiction. Provided, however, that no agreement herein, shall be deemed a waiver by any Party of Its right to judicial enforcement of this Stipulation. 4. Upon full execution of this AGREEMENT, the Parties agree not to seek any type of penalties, fines, reimbursements or pre and post determination interest, attorneys’ fees and costs in relation to this case. 5. Upon full execution of this AGREEMENT, the Parties agree that venue for any action brought to enforce the terms of this AGREEMENT or the Final Order entered pursuant hereto shall lie in the Circuit Court in Polk County, Florida. 6. By executing this Stipulation, FURBEE does not agree with or admit to the conclusions in the AGENCY letter of September 30, 2003. 7. Upon full execution of this AGREEMENT, the AGENCY agrees that it will issue a = new letter that supercedes and rescinds the letter dated September 30, 2003. The new ~ letter will clarify that the Agency did not determine that there was a pattem or practice of | (AHCA No. 2003007787) FURBEE v. AHCA (BMHC ID: 20030115-001.04 (Work. Comp.)) _ Page 3 of 7 06/21/04 16:17 FAX igyuuesuug ' ero : Kyle Furbee,D.C..P.A. Fax: (86 FAX ND. : e63 sa2 se5a a 21 aed 2:23 paygros 13:23 FAX 941 413 1292 “SMITH, PEDDELERA GJ. AL. - uns ae PL ae : P. ~T Jywie-zees 1357 ovenutiization ard did not determine that FURBEE had Violated Chapter 440, Florida statutes, or rules adopted by the AGENCY, The draft letter Is attached as Exhibit A. 8. Upon full execution of this AGREEMENT, the AGENCY agrees that it will not impose any sanction under § 440.13(8)(b) against FURBEE for treatment by FURBEE provided from May 13, 1983 through October 16, 2002 (the tearments covered by the Agency letter) for this particular Injured worker for the July 18, 4684 accident. . , . KE 9, Upon full execution of this AGREEMENT, dha AGENCY shail enter a Final Order adopting and incarparating the terms of this AGREEMENT and dismissing the above styled case. 40, sch ofthe Parties shal! bear Its own costs and attorneys’ faas. ' | tt. ‘This AGREEMENT shall become effective on the date upon which K is fully axecuted by all Perties. : . Wz KYLEE, FURBEE, D.C., for himeett and his halrs, successors, assigns, . transferees, attorneys, executors OF administrators, doas hereby discharge the AGENCY FOR HEALTHCARE ADMINISTRATION (Including all related or resulting organizations, units, divigions, fts successors OF traneferees), and the AGENCY'S | Agents, Representatives, alomeys, helrs, and executors or administrators, from all claims, demands, actions. causes of actions, suits, damages, loses and expenses, of any kind and evary Hature whatsoever, arising out of of in any wey related to this matter and tha aforementioned AGENCY'S actions, Including, but not limited to, any claims that were or may ba sssefted in any Federal or State Court or administrative forum, Including any craims arising out of this AGREEMENT, by of 97 behalf of Kyla E. Furbee, D.C, (AHCA No. 2003007787) FURBEE v. ANCA (BMHC ID: 20030115-001.01 (Work. Comp.}) Row Page of 7 621/64 16:17 FAX ee er Wo03g7g0g 13. The AGENCY, for itself and for its related or resulting organizations, units, divisions, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge KYLE E. FURBEE, D.C., his agents, heirs, assigns, transferees, attorneys, representatives of and from all clams, demands, actions, causes of action, suits, damages, loses and expenses, of any nature whatsoever, arising out of or in any way related to this matter and the AGENCY'S actions, including, but not limited to, any claims, causes of action, administrative agency action that have, 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 Kyle E. Furbee, D.C. excepting actions based upon subsequent findings of overutilization on any other unrelated Workers’ Compensation matters. 14. This AGREEMENT is binding upon all the Parties herein. 45. The undersigned have read and understand this AGREEMENT and have authority to bind their respective principles to it. | 16. This AGREEMENT contains the entire understanding and agreements of the Parties. . " 17. This AGREEMENT supersedes any prior oral or writtan agreements between the Parties. | 48.. AFAGSIMILE SIGNATURE contained herein shall be as valid and binding as an original signature thereof. THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK (AHCA No. 2003007787) FURBEE v. AHCA (BMHC ID: 20030115-001.021 (Work. Comp.)) Page 5 of 7 ——E—————— 06/21/04 15:47 FAX ; Hi ' i FROM : Kyle Furbee,D, Cc. .P.AR. Fax: (86 FAX ND. : 863 ea2 esa Jun. 21 2eea @2:19PM Fi. . AS ee ta tee eee vas Ae PM A Wuvesuus , : P.ae —~"Fin-je-2004 15158 - 419. This AGREEMENT may not be amended except in writing, Any athempted be void. The following representatives tiave nto this AGREEMENT: assignment of thia AGREEMENT shall hereby acknowledged that they are duly quthorizad to enter I ETIZABETH DUDEK DEPUTY SECRETARY ‘ HEALTH QUALITY ASSURANCE “FOR PETITIONER AGENCY FOR HEALTH CARE ADMINISTRATION 2727 MAHAN DR MAIL STOP 3 TALLAHASSEE, FL 32308 2 2 Ipenre: Die 21-pb { | “DATED: Lee vie , VAL & GENERAL COUNSEL “1 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 MAHAN DRIVE MAIL STOP. 3 TALLAHASSEE, FL 32308 paves 6 / h/t (EXHIBIT "A" IS ON THE FOLLOWING PAGE) (AHCA No. 2003007787) FURBEE V. AHA {BMH ID; 20030115-001.01 (Work. Comp.) Pegs G of 7 DIVISION OF HEALTH QUALITY ASSURANCE ; BUREAU OF MANAGED HEALTH CARE EXHIBIT A WORKERS’ COMPENSATION UNIT - DATE CERTIFIED MAIL 7003 2260 0007 2000 5576 RETURN RECEIPT REQWESTED KYLE C. FURBEE, D.C. FIRAFTL 314 PARKVIEW PL LAKELAND FL 33805 RE: Injured Employee: © REDACTED ** Actual Letter will have the redacted data ** '. SSN: REDACTED Injury Date: 7/19/1984 BMHC Case ID: 200301 15-001.01 n 4 Dear Dr. Furbee: This letter supersedes and rescinds the Agency’s letter of September 30, 2003 (sent certified mail no. 7000 1530 0000 1829 2666). The Agency received a January 23, 2003 report from the attorney for United Self-Insured Services, regarding the carrier’s reports of overutilization concerning services you provided to the above-referenced injured employee from May 13, 1993 though October 16, 2002. The Agency reviewed this report pursuant to subsection 440,13(8)(b), Florida Statutes (F.S.). That subsection authorizes the Agency to impose penalties only “if the agency determines that a health care provider has engaged in a pattern or practice of overutilization or a violation of this chapter or rules adopted by the agency.” Based upon the agency’s revjew of all timely submitted evidence, , it is concluded thatyou have not ‘engaged in the overutilization of services as it relates to the employee identified above. The Agency had no other basis of review. ; Specifically, the Agency’s review did not reveal a pattern or practice of overutilization of services or a violation of this chapter or rules adopted by the Agency. This review is closed. Sincerely, Merle Barnett ’ Registered Nurse Specialist cc: W JOHN GADD, ESQ. SMITH FEDDELER SMITH & MILES P.A. PO BOX 1089, LAKELAND FL 33802-1089 CERTIFIED MAIL 0000 1111 2222 3333 4444 RETURN RECEIPT REQUESTED MB/ (AHCA No. 2003007787) FURBEE v. AHCA (BMHC ID: 20030115-001.01 (Work. Comp.)) Page 7 of 7

Docket for Case No: 04-001620