CERTIFIED MAIL NOS. 7003 1010 0000 9716 0328 & 7003 1010 0000 9716 0311 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, aw y Sr % vs. Case No. 2003009149 Bp? ¢. perc FF Oyen ee LAKESIDE ALTERNATIVE, INC., - Seon ° d/b/a LAKESIDE ALTERNATIVES, a { | ; % ( j ( 7 4 Respondent. ee ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against LAKESIDE ALTERNATIVE, INC., d/b/a, LAKESIDE ALTERNATIVES (hereinafter “Respondent”), pursuant to Section 120.569, and 120.57, Florida Statutes, (2004), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine pursuant to Rule 59E- 2.024(3)(a) and (5), and 59E-2.025(1)(a), Fla. Admin. Code, and Section 408.08(2) Florida Statutes, (2002) and as a result of a violations of Section 408.061(4)(a), Florida Statutes, (2002) and Rule 59E-5.201, Fla. Admin. Code. DICTION 2. The Agency has jurisdiction over licensure and fines of the hospital pursuant to Chapter 395, Florida Statutes, (2002) and Chapter 59A-3, Fla. Admin. Code. VENUE 3. Venue shall be determined pursuant to Rule 28-106.207, Fla. Admin. Code. ExH pir A" PARTIES 4. The Agency is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing hospitals pursuant to Chapter 395, Florida Statutes, (2002), and Chapter 59A-3 Fla. Admin. Code. 5. The Agency is the regulatory authority responsible for collecting and enforcing the hospital reporting requirements as required in Chapter 408, Florida Statutes, (2002), and Chapter 59A-3 Fla. Admin. Code. 6. Respondent is licensed as a hospital pursuant to Section 395.002(13), Florida Statutes. COUNT I RESPONDENT FAILED TO FILE A COMPLETE AND/OR ACCURATE PRIOR YEAR REPORT IN A TIMELY MANNER VIOLATING § 408.061(4)(a), F.S. AND RULE 59E-5.201 and 59E-2.024(5), F.A.C. 7. The Agency realleges and incorporates by reference paragraphs (1) through (6) as if fully set forth herein. 8. The Respondent failed to submit a complete and accurate Prior Year Report for its 2002 fiscal year within 120 days subsequent to the end of the facilities fiscal year pursuant to Section 408.061(4)(a), Florida Statutes and Rule 59E-5.201, Fla. Admin. Code. 9. The Respondent failed to file the complete Prior Year Report on the due date of October 28, 2002, to meet statutory requirements. 10. The Agency sent a notice of violation to the Respondent on December 10, 2002, which specified the corrections needed to bring the hospital’s report into compliance with statutory and rule requirements, allowed ten (10) working days to provide the Agency with the requested information, and gave notice that Respondent would be subject to imposition of an administrative fine if the requested information was not timely filed pursuant to Rule 59E-2.024(5), Fla. Admin. Code, Violation of Chapter 408 Florida Statutes or Board Rules, which states in part: (5) Prior to seeking to impose an administrative fine against an entity for the violations described ... the Agency will send a notice of violation to the entity by certified mail, return receipt requested. If the entity corrects the violation within 10 working days of receipt of the notice, no violation will be deemed to have occurred and no administrative fine will be sought or imposed. If the entity does not correct the violation within that time, it shall be subject to imposition of an administrative fine which will be calculated from the original due date of the report or document. lL. The Respondent received the notice of violation on December 13, 2002. 12. A copy of the notice of violation is attached hereto as Exhibit “1” and incorporated herein by reference. 13. The Respondent failed to provide the Agency with the requested information specified in the December 10, 2002, notice of violation within ten (10) working days of receipt of the notice. 14, Respondent requested an extension, which was subsequently granted and the due date was extended to November 27, 2002. 15. A copy of the request for extension is attached hereto as Exhibit “2”. 16, A copy of the letter extending the due date to November 29, 2002 is attached hereto as Exhibit “3”. 17. The Respondent failed to provide the Agency with the requested information specified in the December 10, 2002 by the extended due date of November 29, 2002. 18. | The 2002 prior year report was eventually received from the Respondent on May 30, 2003, resulting in a total of 214 days late, calculated pursuant to Rule 59E-2.024(5), Fla. Admin. Code. 19. _ Failure to provide an accurate and/or complete Prior Year Report in a timely manner is a violation of Section 408.061(4)(a), Florida Statutes, and Rule 59E-5.201, Fla. Admin. Code, which requires Respondent to file the Prior Year Report with the Agency within 120 days subsequent to the end of its fiscal year. 20. Section 408.08(2), Florida Statutes, provides that any hospital which refuses to file a report, fails to timely file a report, files a false report, or files an incomplete report shall be punished by a fine not to exceed $1,000 per day for each day in violation, to be fixed, imposed, and collected by the Agency. Each day in violation shall be considered a separate offense. 21. Respondent's violations constitute a Second Occurrence as defined in Rule 59E-2.025(1)(a), Fla. Admin. Code, which results in fine of $40.00 per day starting on the original filing due date of October 28, 2002. This violation constitutes the grounds for which the Agency imposes a fine in the minimum amount of $8,560.00 pursuant to Sections Rule 59E-2.025 (1)(a), Fla. Admin. Code. CLAIM FOR RELIEF WHEREFORE, State of Florida, Agency for Health Care Administration requests the Court to order the following relief against the Respondent for violation of Section 408.061(4)(a), Florida Statutes, (2002) and Rule 59E-5.201, Fla. Admin. Code. pursuant to Rule S9E- 2.024(3)(a) and (5), and 59E-2.025(1)(a), Fla. Admin. Code, and Section 408.08(2) Florida Statutes, (2002) finding: (A) Make factual and legal findings in favor of the Agency on Count I. (B) Recommend administrative fines for a total amount of $8,560. (C) Attorney’s fees and costs; and () All other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (200lp. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308. THE RESPONDENT IS FURTHER NOTIFIED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. Dated on this 26 day of August 2004. Respectfully submitted, Assistant General Counsel Florida Bar ID. 318442 Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U. S. certified mail/return receipt requested on August 24 | 2004 to: James M. Barclay, Esq., 215 S. Monroe Street, Suite 815, Tallahassee, FL 32301 (certified no. 7003 1010 0000 9716 0328) and Lakeside Alternatives, Attention: Jerry Kassab, Chief Executive Officer, 434 West Kennedy Bivd., Orlando, FL 32810 (certified no. 7003 1010 0000 9716 0311). Eric R. Bredemeyer, Assjstant General Counsel ERB/vk/jic : 04 SEP 23 Py CERTIIED MeL BIViSiva December 10, 2002 ADMINIS TRA fF Jerry Kassab Chief Executive Officer Lakeside Alternatives 434 West Kennedy Blvd. Orlando, FL 32810 RE: 2002 Prior Year Report, FYE: 06/30/02 Hospital Number — 10-0129 Deemed-not-Filed Notice of Violation SUONONSUL J0y Osama an i ow” Audited financial Statements Pursuant to rule 59E-5.201 FA. C., your hospital is Tequired to submit the hospital’s audited financial statements, Please submit (1) copy of the audited financial Statements, Draft copies are not accepted, og Medicare Cost Report Pursuant to rule 59E-5.201 F.AC., your hospital is Tequiréd to submit (1) copy of the port, Medicare Cost Report. Please submit (1) Copy of the Medicare Cost Re; | , i 2727 Mahan Drive © Mail Stop #28 Tallahassee, FL 32308 Bl LN Lakeside September 19, 2002 sep 17 2002 Con/Financial Analysis Office Mail Stop 28 Mr. Christopher J. Augsburger Ay we, Regulatory Analyst Supervisor 4 Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 FY 2002 PRIOR YEAR REPORT EXTENSION RE: LAKESIDE ALTERNATIVES, INC. (AHCA #10-0129) Dear Mr. Augsburger: of this letter is to request a 30-day d the prior year report for the fisca! period Inc. This report is currently due on tended until November 27, 2002. With this extension, | can ensure that our prior year report submission will be more accurate. This extension of the due date will allow me a sufficient amount of time to review this report to ensure that it is completed in accordance with AHCA requirements. We would certainly appreciate your consideration of the Altematives, Inc. If you have any questions or need further information, plea: call me. extension for the filing of the audited financial from July 1, 2001 to June 30, 2002 for The purpose October 28. 2002. We are requesting statements ani Lakeside Alternatives, that this due date be ex! extension request for Lakeside se do not hesitate to Sincerely, Caria Caper Carla Caponi Director of Finance FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION JEB BUSH, GOVERNOR CERTIFIED MAIL 7001 0360 0003 3808 5356 September 18, 2002 Carla Caponi Director of Finance Lakeside Alternatives 434 W. Kennedy Boulevard Orlando, Florida 32810 RE: 2002 Prior Year Report, FYE 6/30/2002 AHCA #10-0129 Original Due Date: October 28, 2002 Extended Due Date: November 29, 2002 Dear Ms. Caponi: RHONDA M. MEDOWS, Mo, FAAFP, SECRETARY EXHIBIT This is to acknowledge the receipt of Lakeside Alternatives, Inc.’s letter dated September 19, 2002 requesting the due date for the above referenced report be extended. Based on the circumstances outlined in the above request, an extension is approved. However, please be aware that any additional extension requests would impair the Agency’s ability to meet ~ publication deadlines and other statutorily mandated duties and will, therefore, not be granted. Please have your report in the Agency’s office by the close of the extended due date. Section 395.701 of the Florida Statutes requires that your net operating revenue be certified by the Agency. If the above extension results in a quarterly assessment being based on other than the most recent actual fiscal year, an adjustment will be necessary.. The adjustment will be made in the next quarterly assessment. This extension is applicable only to the above referenced reports. Extension of the due date for other required AHCA reports must be specially requested. The Agency expects that all reports will be filed on a timely basis. Since: yy v fistopher J. Augsburger Regulatory Analyst Supervisor A es a 2727 Mahan Drive « Mail Stop #i Talinkanen. ET 299N0 Visit AHCA online at

Docket for Case No: 04-003467