Petitioner: PHARMA-EXPRESS, INC.
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: PATRICIA M. HART
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: May 26, 2004
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, August 9, 2004.
Latest Update: Dec. 23, 2024
i LED
STATE OF FLORIDA evetea f
AGENCY FOR HEATH CARE ADMINISTRATION SEte CLERK
PHARMA-EXPRESS, INC.,
yn-C 16 S
Petitioner, P
vs. CASE NO. \ 04-1885MPI
Audit No. 04-2114-000,
AGENCY FOR HEALTH CARE 0 UB ;
ADMINISTRATION, = “Y
Respondent. an ‘
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wl
FINAL ORDER '
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THE PARTIES resolved all disputed issues and executed
a “settlement agreement”, which is incorporated |<
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 xe day of
Ss
ange , 2004, in Tallahassee, Florida.
foe Kian Levine, Secretary
Agency for Health Care Administration
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:
Lawrence Metsch
Metsch & Metsch, P.A.
1455 NW 14 Street
Miami, Florida 33125
Debora Fridie, Esquire
Attorney for Agency
“AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive
Fort Knox Building 3, Mail Stop 3
Tallahassee, Florida 32308
Patricia Malono
Administrative Law Judge
Division of Administrative
Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Medicaid Program Integrity
Finance & Accounting
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the
foregoing has been furnished to the above named addressees
by U.S. Mail on this the i day of aa ;
20038.
Foe gency Clerk
7 ‘'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 H INGS
TO 4 2004
PHARMA-EXPRESS, INC.
Petitioner, Case No.: 04-1885MPI
C.I. No.: 04-2114-000
vs.
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent .
STIPULATION AND AGREEMENT
——— EE SERENE
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and PHARMA-EXPRESS, INC. (“PROVIDER”),
by and through the undersigned, hereby stipulate and agree as
follows:
1. The two parties enter into this agreement for the
purpose of memorializing the resolution to this matter.
2. PROVIDER is a Medicaid provider in the State of
Florida, operating under provider number 0224430 00.
3. In its Final Agency Audit Report C.I. No. 04-2114-000
{the "Audit Letter") 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 repayment of an
overpayment in the amount of $7,735.79. In response, PROVIDER
Page 1 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
petitioned for a formal administrative hearing with the Division
of Administrative Hearings, Case No. 04-1885MPI. PROVIDER has
agreed to pay the overpayment plus some of AHCA’s investigative
costs, in the amount of $2,000.00, for a total repayment of
$9,735.79.
4. In order to resolve this matter without further
administrative proceedings, PROVIDER and AHCA expressly agree as
follows:
(a) AHCA will accept the payment set forth herein as
. settlement of the overpayment issues arising from.
the MPI review cited in paragraph 3 above.
(b) Within thirty (30) days of issuance of the Final
Order, PROVIDER agrees to make a single payment to
AHCA of Nine Thousand Seven Hundred Thirty-Five and
79/100 Dollars ($9,735.79). Of this amount,
$7,735.79 is to reimburse the Medicaid program for
overpayments, and $2,000.00 is to reimburse AHCA for
investigative costs. AHCA retains the right to
perform a 6-month follow-up review.
(c) PROVIDER is responsible for ensuring timely delivery
of the payment. Failure to timely make the payment
will render the balance due and payable immediately,
Page 2 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
(d)
(e)
(£)
with interest, and interest will continue to accrue
until the entire balance is paid.
PROVIDER and AHCA agree that full payment as set
forth above will resolve and settle this case
completely and release all parties from all
liabilities arising from the findings in the audit
referenced as C.I. 04-2114-000.
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.
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 stipulation
and agreement and shall reference the C.I. Number and the
Provider Number.
Page 3 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
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 Stipulation
and Agreement under the laws of the State of Florida, the Rules
of the Medicaid Program, and all other applicable rules and
regulations. ; . ae
8. Except as specifically set forth in paragraphs 3 and
4(b) above with regard to AHCA’s investigative costs, the
parties agree to bear their own attorney’s fees and other costs,
if any.
9. 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 Stipulation.
and Agreement to AHCA; however a facsimile copy shall be
sufficient to enable AHCA to cancel a hearing scheduled in this
case.
Page 4 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
10. 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.
11. 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 shall be valid unless a
written amendment to the Agreement is completed and properly
executed by the parties.
12. 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 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 matter. However, the
parties believe that this matter should be resolved because the
Page 5 of 9
‘case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
Parties have agreed to the terms contained within this
agreement.
13. 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 igs consistent
with the terms of this stipulation and agreement, that. adopts |
this agreement and closes this matter.
14. 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 expenses,
of any and every nature whatsoever, arising out of or in any way
related to this matter, C.I. No. 04-2114-000, 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.
Page 6 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
15. 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.
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.
woos 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.
Page 7 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
PETITIONER PHARMA-EXPRESS, INC.
CAtotinrt MEL. Dated: Ook. iy , 2004
Sa
BY:
(Printed name and title)
METSCH AND METSCH, P.a.
Dated! / , 2004
Page 8 of 9
Case No: 04-1885MPI
C.I. No. 04-2114-000
Pharma-Express, Inc. vs. AHCA
Stipulation and Agreement
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
Dated: Te ~__, 200¥
J. Ss D. BO
Inspector General
Dated: LC? eo , 2004
General Counsel
Da am ole! pated: oven bas & 2004
DEBORA E. FRIDIE
Assistant General Counsel
Page 9 of 9
Docket for Case No: 04-001885MPI
Issue Date |
Proceedings |
Jan. 07, 2005 |
Final Order filed.
|
Oct. 21, 2004 |
Notice of Service of Interrogatories, Request for Admissions, & Request for Production of Documents (filed by G. Dearborn via facsimile).
|
Aug. 09, 2004 |
Order Closing File. CASE CLOSED.
|
Aug. 06, 2004 |
Notice of Settlement and Joint Motion to Close File (filed by Petitioner via facsimile).
|
Aug. 02, 2004 |
Respondent`s Amended Notice of Telephonic Deposition of Designated Corporate Representative (filed via facsimile).
|
Aug. 02, 2004 |
Respondent`s Notice of Telephonic Deposition of Designated Corporate Representative (filed via facsimile).
|
Jul. 28, 2004 |
Respondent`s Motion for Official Recognition filed.
|
Jul. 28, 2004 |
Respondent`s Motion for Costs (filed via facsimile).
|
Jul. 20, 2004 |
Notice of Substitution of Counsel
|
Jul. 02, 2004 |
Respondent`s Withdrawal of Numbers 21, 22, 23 of AHCA`s First Request for Admissions (filed via facsimile).
|
Jun. 09, 2004 |
Amended Notice of Hearing (hearing set for August 16, 2004; 9:00 a.m.; Tallahassee, FL; amended as to correct the Issue).
|
Jun. 07, 2004 |
Notice of Service of Interrogatories, Request for Admissions, & Request for Production of Documents (filed by Respondent via facsimile).
|
Jun. 07, 2004 |
Order of Pre-hearing Instructions.
|
Jun. 07, 2004 |
Notice of Hearing (hearing set for August 16, 2004; 9:00 a.m.; Tallahassee, FL).
|
Jun. 04, 2004 |
Unilateral Response to Initial Order (filed by Respondent via facsimile).
|
May 28, 2004 |
Initial Order.
|
May 26, 2004 |
Petition for Formal Hearing filed.
|
May 26, 2004 |
Final Agency Audit Report filed.
|
May 26, 2004 |
Notice (of Agency referral) filed.
|