STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS FARMACIA MARTINEZ, INC., Petitioner, vs. DOAH CASE NO. 04-3460MPI AUDIT NO. C.I. 04-2097-000/H/KLH PROVIDER NO. 021964900 2 STATE OF FLORIDA, AGENCY FOR sx HEALTH CARE ADMINISTRATION, Y HM Respondent. A P , Ws FINAL ORDER THIS CAUSE came before me for issuance of a Final Order on a Final Agency Audit Report (“FAAL”) dated August 10, 2004 (audit number C.1. 04-2097-000/H/KLH). By the FAAL, the Agency for Health Care Administration (“AHCA” or “Agency”), informed the Petitioner, Farmacia Martinez, Inc., (hereinafter “PROVIDER”), that the Agency was seeking to recover Medicaid overpayments in the amount of $1,223.08. The FAAL provided full disclosure and notice to the PROVIDER of procedures for requesting an administrative hearing to contest the alleged overpayment. The PROVIDER filed a petition with the Agency requesting a formal administrative hearing. The Agency transmitted Petitioner’s hearing request to the Division of Administrative Hearings for conduct of a formal administrative hearing. The PROVIDER, through counsel, then withdrew the petition for formal administrative hearing and the DOAH case was dismissed by the Administrative Law Judge on October 5, 2004, and jurisdiction of the case relinquished by the Division to the Agency. FINDINGS OF FACTS The PROVIDER received the FAAL that gave notice of PROVIDER’S right to an administrative hearing regarding the alleged Medicaid overpayment. The PROVIDER filed a petition requesting an administrative hearing, and then caused that petition and the administrative hearing to be DISMISSED. Petitioner chose not to dispute the facts set forth in the Final Agency Audit Report dated August 10, 2004. The facts alleged in the FAAL are hereby deemed admitted, including the total overpayment amount of $1,223.08. The Agency hereby adopts the facts set forth in the FAAL, including that the amount of $1,223.08 is now due and owing, from PROVIDER to the Agency, with interest, since the date of August 10, 2004. CONCLUSIONS OF LAW The Agency incorporates and adopts each and every relevant statement and conclusion of law set forth in the Final Agency Audit Report dated August 10, 2004. The admitted facts support the legal conclusion that the overpayment in the amount of $1,223.08, is now due and owing from PROVIDER to the Agency. Under Section 409.913, Florida Statutes, interest accrues on this overpayment amount at 10% annually from August 10, 2004. Based on the foregoing, it is ORDERED AND ADJUDGED that PROVIDER remit, forthwith, the sum of $1,223.08, together with statutory interest as set forth in Section 409.913, Florida Statutes, from the date of August 10, 2004. The Petitioner’s request for an administrative hearing is hereby DISMISSED. He DONE AND ORDERED this a2¢™ aay of sar“, 2005, in Tallahassee, Florida. A fo ‘Alan 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: Michael P. Gennett Shutts & Bowen, LLP 201 S. Biscayne Blvd. Suite 1500 Miami, FL 33131 David W. Nam, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida (Interoffice) Tim Byrnes, Chief Agency for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive Tallahassee, Florida (Interoffice) (Iftteroffice) Finance & Accounting (Interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished via postage-paid U.S. Mail, Inter-office Mail, E-mail and/or Facsimile Transmission to the above named persons dated on this - } 3 day of | tellpssib / , 2005.

Docket for Case No: 04-003460MPI