CERTIFIED MAIL NOS. 7001 0360 0003 3804 3714 & 7001 0360 0003 3804 3707 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2003009149 LAKESIDE ALTERNATIVE, INC, ADD4OOFS 4 d/b/a LAKESIDE ALTERNATIVES, a OY BULK Respondent. Sa | ADMINISTRATIVE COMPLAINT COMES Now the AGENCY FOR HEALTH CARE ADMINISTRATION ’ (hereinafter: *Ageney’), 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, ard 120.57, Florida Statutes, (2004), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine pursuant to Rule 59E- 1. 2.024(3)(a) and (5), and.59E-2.025(1)(a), Fla: Admin. Code, and Section 408.08(2) Florida Statutes, (2001) and as a result of a violations of Section 408.061(4)(a), Florida Statutes, . (2001) and Rule 59E-5.201, Fla. Admin. Code. SDICTION 2. The Agency has jurisdiction over licensure and fines of the hospital pursuant to Chapter 395, Florida Statutes, (2001) and Chapter 59A-3, Fla. Admin. Code. VENUE Venue shall be determined pursuant to Rule 28-106.207, Fla. Admin. Code. l ff Ex B( Bit A PARTIES 1 . feng - | 4. The Agency is the regulatory authority responsible for liceti§tre™ and ! 1 enforcement of all applicable statutes and rulds governing hospitals pursuant to Chapter 395, Florida Statutes, (2001), and Chapter 59A-3 Fla. Admin. Code. = 5. The Agency is the regulatory authority responsible for collecting and enforcing the hospital reporting requireménts as required ‘in Chapter 408, Florida Statutes, (2001), 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 7 RULE 59E-S.201 and 59E-2.024(5 , F.A.C. 7 ' 7. The Agency realleges and incorporates by reference paragraphs (1) through (6) as if fally set forth herein. . 8. The Respondent failed to submit a complete and accurate Prior Year Report for its 2001 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 Prior Year Report on the due date of October 28, 2001, to meet statutory requirements. 10. The Agency sent a notice of violation to the Respondent on December 6, . 2001, 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. 11. The Respondent received the notice of violation on December 12, 2001. 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 Agéncy with the requested information _ specified in the December 6, 2001, notice of violation within ten (10) working days of Teceipt of the notice. . 14. The Agency sent a second notice informing the Responderit of delinquent filing on February 13, 2002. 15. Proof of delivery could not be established for the second notice’ of February 13, 2002. ; 1 16. A copy of the notice of violation is attached hereto as Exhibit “2” and incorporated herein by reference. 17. The Respondent failed to provide the Agency with the requested information specified in the February 13, 2002 notice of violation within ten (10) working days of receipt of the notice. 18. The Agency sent a third notice informing the Respondent of delinquent filing on May 24, 2002 indicating that the audited financial statements required as part of the 2001 prior year report were not received. 19 002. . ! A copy of the notice of vidlation is attached hereto as Exhibit “3” and incorporated herein by reference. 21. The Respondent failed to provide the Agency with the requested information specified in the May 24, 2002 notice of violation within ten-(10) working days of receipt of the notice. ' 22. The Agency sent a fourth notice informing the Respondent “of delinquent filing on July 10, 2002 indicating that the audited financial statements Tequired as part of the 2001 prior year report were not received. 23. | The Respondent received the fourth notice of violation.on July 12, 2002. 24. A copy of the notice of violation is attached hereto as Exhibit “4” and incorporated herein by . reference. 25.The Respondent failed to provide the Agency with the requested information specified i in the July 10, 2002 notice of violation within ten (10) working days of receipt of the notice. 26. The Agency sent a fifth notice informing the Respondent of delinquent filing on August 15, 2002 indicating that the audited financial statements required as part of the 2001 prior year report were not received. 27. _° The Respondent received the fifth notice of violation on August 19, 2002. 28. A copy of the notice of violation: is attached hereto as Exhibit “5” and incorporated herein by reference. 29. The Respondent failed to provide the Agency with the requested information specified in the August 15, 2002 notice of violation within ten (10) working days of Teceipt of the notice. 30. The 2001 prior year report was eventually received on April 1, 2003 resulting in a total of 520 days late, calculated pursuant to Rule 59E-2.024(5), Fla. Admin. Code. 31. 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. 32. 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. ry 33. Respondent's violations constitute a First Occurrence as defined in Rule 59E- | *2.025(1)(a), Fla. Admin, Code, which results in fine of $20.00 per day starting on the original filing due date of October.28, 2001. This violation constitutes the grounds for which the Agency imposes a fine in the minimum amount of $10,400.00 pursuant to Sections Rule 59E- 2.025 (1)(a), Fla. Admin. Code. COUNT RESPONDENT FAILED TO FILE A COMPLETE AND/OR ACCURATE PRIOR YEAR REPORT VIOLATING § 408.061(4)(a), F.S. AND RULE 59E-5.201 F.A.C, WITHIN A YEAR OF THE DUE DATE RESULTING IN'A FINE OF $25,000. PURSUANT TO RULE 59E-2.024(3)(c) AND 59E-2.025(1)(c), F.A.C. 34. The Agency realleges and incorporates by reference paragraphs (1) through (6) as if fully set forth herein. 35. The Agency realleges and incorporates by reference paragraphs (7) through (33) as if fully set forth herein. 36. Respondent “failed to file the report” within one year of the: datey the ! : ON Respondent teceived the notice of violation, according to Rule 59E-2.024(6).Fla” Admin. Code violating Section 408.061(4)(a), Florida Statutes, and Rule 59E-5.201, Fla. Admin. Code. 37. Pursuant to Rule 59E-2.024(6), Fla. Admin. Code, Violation of Chapter 408 Florida Statutes or Board Rules, which statés in part: _ (6) Prior to seeking to impose an administrative fine against an entity for the: violation described in (3)(c) above, 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 date of the entity’s receipt of the notice of violation. "38. 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. 39. Rule 59E-2.025(2) Fla. Admin. Rule states that no fine may be assessed which exceeds $1,000 per day for each day in violation. 40. Respondent failed to file the report and/or it contained-errors or deficiencies. Rule 59E-2.024(3)(c) Fla. Admin. Code states.in part: (3) Violations that may occur include: but are not limited to: (c) Failure to file a report or document. This violation occurs when the report or document is not submitted within one year of its original due date or when a report or document is submitted but it does not contain all required information or does not meet format requirements. 41. Respondent failed to file the report by December 11, 2002 that is one year of. the date the Respondent received the notice of violation. 42. Rule 59E-2.025(1)(c), Fla. Admin. Code provides when a report is not filed within one year of the Respondent’s receipt of the notice of violation, Respondent shall be © subject to a fine of $25,000 for failure to file a report. . CLAIM FOR RELIEF WHEREFORE, State of Florida, Agency for Health Care Administration requests - the Court to order the following relief against the Respondent for continued violation of ; ; Section 408.061(4)(a), Florida Statutes, (2001) and Rule S9E-5.201, Fla. Admin. Code. | pursuant to Rule 59E-2,024(3)(a) and (5), and S9E-2.025(1)(a),. Fla. Admin. Code, and _ Section 408.08(2) Florida Statutes, (2001) finding: (A) Make factual and legal findings in favor of the Agency on Counts I and II; . ; (B) Recommend administrative fines and fees for a total amount of $25,000 plus $10,400. 00 be imposed against the Respondent as follows: 1. The minimum amount of $10,400.00 for failure to file the bor Report pursuant to Section 400.408, Florida Statutes; . , 2. A fine of $25,000 for failure to file a report as provided Rule 59E- 2.025(1)(c), Fla. Admin. Code; (C) Attomey’s fees and costs; and (D) 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 (2004). 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 1S NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADM! WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE, COMPLAINT, A FINAL ORDER WILL BE ENTERED. ee a Dated on this 2 day of August 2004. ' Respectfully'submitted, Eric R. Bredemeyer Assistant General Counsel Florida Bar I.D. 318442 Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive ; . Tallahassee, FL 32308 4 « (850) 922-5873 (office) ' Ne CERTIFICATE OF SERVICE - , I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U. S. certified mmailéretumn receipt requested on August 2S, 2004 to: James M. Barclay, Esq., 215 S. Monroe Street, Suite 815, Tallahassee, FL 32301 (certified no. 7001 - 0360 0003 3804 3684) and Lakeside Alternatives, Attention: Jerry Kassab, Chief Executive Officer, 434 West Kennedy Bivd., Orlando, FL 32810 (certified no. 7001 0360 BUR. Eric R. Bredemeyer Assistant General Counsel] 0003 3804 3691). ERB/vk/jlc 7000 O600 0024 9203 £454 i} STATE OF FLORIDA 4 i : i i fm ee sf 27 eo ‘ 2 - £ Fe a 4 y es £2 am ? & af 87 2m Py coed ; 3 s2 , eb JEB BUSH, GOVERNOR = 3 fm be nee] CERTIFIED MAIL ce 3 py December 6, 2001 Oz om UL! §'U Terésa B. Soderlund Z fi} ; 37 Chief Executive Officer ; § i s Lakeside Alternatives ° i & 1800 Mercy Drive = Orlando, FL 32808 , . RE: 2001 Prior Year Report, FYE: 06/30/01 “H 100129 De Deemed Not Filed : ' AG Notice of Violation RBG: . ‘ . Ze ‘ C Dear Ms. Soderlund: , : Been €, uy 3 E-5.204 and 59E-5.206 F.AC., the above referenced Pursuant to rule 59E-2.024, 59E-5.103, 59 : d not filed for the following reason(s): report has been found incomplete and deeme iw Prior Year Actual Report ' . Pursuant to rule 59E-5.201 and 59E-5.206 F.A.C., your hospital is required to submit to | ; the Agency its actual report in electronic format. Please submit (1) 3.5 inch diskette pursuant to the formatting requirements provided in Rule 59E-5.206. via Audited financial statements ~ Pursuant to rule 59E-5.201 F.A.C., your hospital is required to submit the hospital’s “audited financial statements. Please submit (1) copy of the audited financial statements. Draft copies are not accepted. ow Medicare Cost Report : Pursuant to rule 59E-5.201 F.A.C., your hospital is required to submit (1) copy of the * Medicare Cost‘Report. Please submit (1) copy of the Medicare Cost Report. - EXHIBIT Cn cara 727 Mahan Drive - Mail Stop #28 Visit AHGA Online at i www fdhe.siaie fi. us Zz Tallahassee, FL 32308 BOIAITS [e}SOY “SN ‘| Pursuant to rule 59E-2.024(5), please submit the required informatign within 10 working days — from the date you receive this letter. Any subsequent administrative fines will be! imposed from the due date of the Teport. 7 "Section 408.08 of the Florida Statutes provides that any hospital which refuses to file on a timely basis reports or other information required to be filed with the Agency, shall be punished by a ‘fine not to exceed $1,000 per day for each day in violation. Failure to provide these corrections will result in the matter being forwarded to our legal counsel for appropriate action. ‘ ' Thank you very much for your cooperation. If you have any questions, please contact me at 850- 922-7750... Sincerely do Cid : Melvin Austin Regulatory Analyst . SENDER: COMPLETE THIS SECTION = C&mplete items TY, and 3. Also complete | item 4 if Restricted Delivery is desired. use ; ® Print your name and address on the rev | ‘so that we can return the card to you. § Attach this card to the back of the mailpiece, or on the front if space permits. fo - 012: 1. Article Addressed to: LaleS de Atened D. \s deikery address different from tem 1?) Yes tf YES, enter delivery address below. 1 No j 3. Service Type Wgeniiies Mail 0) Express Mail 0 Registered D Retum Receipt for Merchandise OD insured Mai OCOD. i — ee Diode how 2._Article Number coorben service label) PS.Form 381 1, July 1999 Domestic Retum Receipt 102595-00-M-0952 * | VUUL UbUU Ue Acua care ! . H gi a @ s STATE OF FLORIDA uo) 2 i 7 8 ’ Bae 32 i _ 5 ' i gi = £3 He : = i & BG agar i é = Bo: | Te _ KGENCY FOR HEALTH CARE ADMINISTRA | z i i = JEB BUSH, GOVERNOR g . CERTIFIED MAIL 3 Q February 13, 2002 5 . : & Teresa B. Soderlund ag s. Chief Executive Officer &. Lakeside Alternatives . 1800 Mercy Drive Orlando, FL 32808 i RE: 2001 Prior Year Report FYE: 06 AHCA#: 10-0129 : ‘ ; , neon Dear Ms. Soderlund: . yy - : uy . . . . Gy ’ Please be advised that the Agency has.not received the above referenced report which was due in our office October 28, 2001. On December 6, 2001 you were notified by certified letter of the hoSpital’s noncompliance with this filing requirement and our certified mail receipt indicates you received the notice on December 12, 2001. Rule S9E-2.021 of the Florida Administrative Code allows the hospital 10 working days after the receipt of the notice to file the delinquent report. Section 408.08 of the Florida Statues provides that any hospital which refuses to file or fails to file a report when required by the Agency, shall be punished by a fine not to exceed $1,000 per day for each day it is late. Unless you respond immediately, this office will file an administrative complaint against the facility in order to gain your compliance. You may contact Melvin Austin at (850) 922-7750 to receive assistance in resolving this issue. Sincére ee cent istopher J. Augsburger Regulatory Analyst Supervisor ~ EXHIBIT Visit AHCA Online at 2727 Mahan Drive « Mail Stop #28 ww: 7 www.fdhe.state.fl.us Tallahassee, FL 37308 1dlS03Y TVW G3IsILYs9 ‘& pe} . = 74 E 35} : Z 5 5 4 JEB BUSH, GOVERNOR ES SF ' : > x CERTIFIED MAIL’ , $0 May 24, 2002 g iS , 5 3 "Teresa B. Soderlund _£ é Chief Executive Officer — ae = 8 Lakeside Alternative, Inc. ‘ ; z 3 1800 Mercy Drive z & Orlando, Florida 32808 A & RE: 2001 Prior Year Report FYE 06/30/01 ' AHCA #: 10-0129 4 - Notice of Violation , . OVE "5 Your report has been received and found to contain errors and/or deficiencies and therefore is considered incomplete, and deemed. not accepted. Enclosed is a copy of the errors and/or deficiencies reflecting these findings. The copy of the Agency's hospital financial data report, representing your hospital's data as entered into our database will be sent with the letter of acceptance, ‘ Dear Ms. Soderlund: Pursuant to rile 59E-2.024 F -A.C., please correct the errors and/or deficiencies that constitute this notice of violation and return to our department within 10 working days from the day you receive this notice. Failure to correct the errors and/or deficiencies will result in the matter being forwarded to our legal department for administrative action. Please include, with your corrected worksheet or new diskette, a cover letter briefly stating which worksheet(s) you corrected. ' Pursuant to section 408.08 F.S., any health care facility that files an incomplete report and upon notification fails to timely file a complete report shall be assessed a fine not exceeding $1,000 per day for each day in violation. : : Thank you very much for your cooperation. If you have any questions, please feel free to contact me at (850) 922-7750.. : : , Sincerely, Melvin Austin . ‘ Regulatory Analyst Enclosure EXHIBIT eee 2727 Mahan Drive « Mail Stop #28 Visit AHCA online at www. fdhe. state fl.us Tallahassee, FL 32308 + HOSPITAL: Lakeside Alternative, Inc. REPORT: 2001 Actual Report _ ANALYST: Melvin Austin Qe Pursuant to Rules 59E-5.205 and 59E-5.102 F.A.C., staff's review of the actual report noted the following errors and/or deficiencies: -WORKSHEETS Other Other A-2 C-1 C-4 NOTICE OF VIOLATION HOSPITAL'NUMBER: 10-0129 ERRORS AND/ OR DEFICIENCIES Cd The audited financial statements for FY 2001 were not filed. Please correct. Please verify bad debts expense, depreciation and amortization expense, insurance expense, interest expense and salaries and benefits with amount reported in the audited financial statements. If the hospital has a controlling organization, please report the name of the controlling organization in section three. : 4 Account 7210 is reported on Worksheet A-2 as separate and discrete service but no standard of units are reported. Please correct. Audited Financial Statements were not filed.'Pursuant to Rules 59E-5.102 and 59E-5.201 F.A.C., the financial data contained in your hospital's actual report must be reported according to Generally Accepted Accounting Principals (GAAP) except as otherwise provided in the Florida Hospital Uniform Reporting System (FHURS) manual. Whenever an actual. report is not in agreement with the corresponding Audited Financial Statements the hospital shall provide a reconciliation of the amounts presented in the Audited Financial Statements to amounts reported in the actual. report. Please provide a "reconciliation of current assets, total assets, current liabilities and total liabilities to the. Audited Financial Statements with an explanation as to how the differences more accurately conform to the FHURS manual reporting requirements, citing page and account number. Audited Financial Statements were not filed. Pursuant to Rules 59E-5.102 and 59E-5.201 F.A.C., the financial data contained in-your hospital's actual report “ must be reported according to Generally Accepted Accounting Principals (GAAP) except as otherwise provided in the Florida Hospital Uniform Reporting System (FHURS) manual. Whenever an actual report is not in agreement with the corresponding Audited Financial Statements the hospital shall provide a reconciliation of the amounts presented in the Audited Financial Statements to. amounts reported in the actual report. Please provide a ‘reconciliation ‘ of total operating revenue, total operating expense and total margin to the’ Audited Financial Statements with an explanation as to how the differences more accurately. conform to the FHURS manual reporting requirements, citing page and account number. Accounts 5870 and.9150 were not detailed on Worksheet X-4. Please correct. Accounts 8850 and 9250 were not detailed on Worksheet X-4. Please correct. : a) “Correction to Hospital FHURS Report Lakeside Alternative, Inc. Page Two \ ' : E-1 No square feet reported for accounts 8690, 8520, 8410, 8330, 4450, 8310, 8750, 8470, 8710, 8350, 7210 and 7150 but expense is reported on ‘Worksheets , Cs and C-6. Please correct or provide an explanation on Worksheet X-4. E-1 No square feet reported for accounts 7210 and 8470 but accounts are reported on Worksheet A-2 as separate and discrete services. Please correct.or provide .. an explanation on Worksheet X-4. ‘El Nursing fte’s should be. reported on Worksheet E-Ib. On Worksheet X-4, please confirm no nursing fte’s for account 8750. ‘ Please consult your FHURS manual for further explanation and clarification. ots reporting requirement, : - Modifications or corrections to various accounts and Worksheet -cell shall be made by resubmitting the entire report using the FADES software and be retransmitted via computer diskette. Please affix a label to the diskette with the following information. b) Hospital Name . ¢) Hospital Number (8 digit format) ta d) Repprting period _ ; e) “Submission Number” which represents a progressive count of the number of diskettes sent to the agency for this report. a) , (RE: LAKESIDE ALTERNATIVES, INC. - #10-0129 Lakeside Al Mr. Melvin Austin Regulatory Analyst Agency for Health Care Administration 2727 Mahan Drive ' Fort Knox Building #3 Tallahassee, Florida 32308-54034 FY 2001 PRIOR YEAR REPORT NOTICE OF VIOLATION Dear Mr. Austin: a ‘0 respond to your letter dated May 24, 2002. Audited Financial Statements for Lakeside 1 bave not yet been finalized. . We anticipate that we that time, we will ‘submit them to you, along with The purpose of this letter is t Alternatives, Inc. for the period July 1, 2000 through June 30, 200 will receive final Audited Financial Statements during July. At explanations to the other Notice of Violation comments. We apologize for this inconvenience. “le you have any questions or need further information, please do not hesitate to ° i call our consultant, Sarah Fitzgerald | at (813) 286-4455, or me. Sincerely, ; Cable Cyn ECEIVE Director of Fiance JUN 25 2002 Con/Financial Analysis Office Sarah Fitzgerald - Healthoare Financial Group, Inc. Mail Stop 28 ce: 10 fey oNsautog) ooyasas Jesed “S'N . FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION JEB BUSH, GOVERNOR t R Qo0zg Ae ‘GORE WHOS Sd CERTIFIED MAIL ' LdlFOIY WW Gases July 10, 2002 " Jerry Kassab : Chief Executive’ Officer Lakeside Alternatives, Inc. 434 West Kennedy Boulevard ‘' Orlando, Florida 32810 (papinoig aGesanog aouesnsuy ON fAte SUONIN NSU] 1OF BSANAAY 99g ’ RE: 2001 Prior Year Report FYE 06/30/01 ' AHCA #: 10-0129 “ Second Notice of Violation ZO. Your report has been received and found to contain errors and/or deficiencies and thege@re-is <. a fo} i=] 2, a 8 a - 3 o 8 uv g 8 z Qa fa] oO 3 Qa i=] =3 8 8 aot A. 3 2. le} & g. i a ~ 8 g g F a 2 & a g o deficiencies reflecting these findings. The copy of the Agéncy's hospital financial data repoit, representing your hospital's data as entered into our database will be sent with the letter of - acceptance. : . Pursuant to rule 59E-2.024 F.A.C., please correct the errors and/or deficiencies that constitute this notice.of violation and return to our department within 10 working days from the day you receive this notice. Failure to correct the errors and/or deficiencies will result in the matter being forwarded to our legal department for administrative action. Please include, with your corrected worksheet or new diskette, a cover letter briefly stating which worksheet(s) you corrected. ' Pursuant to section 408.08 F.S., any health care. facility that files an incomplete report and upon notification fails to timely file a complete report shall be assessed a fine not exceeding $1,000 per day for.each day in violation. ’ Thank you very much for your cooperation. If you have any questions, please feel free to contact me at (850) 922-7750. . oe : ao _ Sincerely, . Melvin Austin Regulatory Analyst Enclosure - EXHIBIT Visit AHCA online at www fdhe. state fl.us 2727 Mahan Drive « Mail Stop #2& Tallahassee, FL 32308 _ NOTICE OF VIOLATION HOSPITAL NUMBER: 10-0129"" ; « ANALYST: -Melvin Austin i & * HOSPITAL: Lakeside Altemative, Inc. ‘REPORT: 2001 Actual Report Pursuant to Rules 59B-5.205 and 59E-5.102 F.A.C., staff's review of the acti SEP 23. py ,,. report noted the following errors and/or deficiencies: #29 Visit ; ay ERRORS AND/ OR DEFICIENCIES\OMIN/5 ip hve. rj San! HEARINGS WORKSHEETS The audited financial statements for FY 2001 were not filed. Please correct. Other Please verify bad debts expense, depreciation and amortization expense, insurance expense, interest expense and salaries and benefits with amount reported in the audited financial statements. \ Jf the hospital has a controlling organization, please report the name of the controlling organization in section three. f . A-2 Account 7210 is reported: on Worksheet A-2 as separate and discrete service ; but no standard of units are reported. Please correct. - Audited Financial Statements were not filed. Pursuant to Rules 59E-5.102 and 59E-5.201 F.A.C., the financial data contained in your hospital's actual report must be reported according to Generally Accepted Accounting Principals (GAAP) ‘except as otherwise provided in’ the Florida Hospital Uniform Reporting System (FHURS) manual. Whenever ‘an actual. report is not in agreement.with the corresponding Audited Financial Statements the hospital ‘ : shall provide a reconciliation of the amounts presented in the Audited Financial Statements’ to amounts reported in the actual report. Please. provide a reconciliation of current assets, total assets, current liabilities and total liabilities to the Audited Financial Statements with an explanation as to how the differences more accurately conform to the FHURS manual reporting requirements, citing page and account number. Audited Financial Statements were not filed. Pursuant to Rules 59E-5.102 and 59E-5.201 F.A.C., the financial data contained in your hospital's actual report must be reported according to’ Generally Accepted Accounting Principals (GAAP): except as otherwise provided in the Florida Hospital Uniform Reporting System (FHURS) manual. Whenever an actual report is not in agreement with the corresponding Audited Financial Statements the hospital shall provide a reconciliation of the amounts presented in the Audited Financial Statements to amounts reported in the actual report. Please provide a reconciliation of total operating revenue, total operating expense and total . nargin to the Audited Financial Statements with an explanation as to how the margi differences more accurately conform to the FHURS manual reporting requirements, citing page and account number. C-2 C-4 Accounts 5870 and 9150 were not detailed on Worksheet X-4. Please correct. C-6 Accounts 8850 and 9250 were not-detailed on Worksheet X-4. Please correct. Lakeside Alternative, Inc. OEE - ' Page Two PE La Tae Bal | "Oh SEP 23. PH: 30 — E-1 No square feet reported for aco ; UR 0, 8410, 8330, 8450, 8310, 8750, 8470, 8710, 8350, 7210 and Hehse 18 reported on Worksheets é ion on Worksheet X-4. ; ' _ €-5S and C-6. Please correct or provide E-1 No square feet reported for accounts 7210-and 8470 but accounts are reported _ on Worksheet A-2 as separate and discrete services. Please correct or provide . . an explanation on Worksheet X-4. : E-1. . Nursing fte’s should -be reported on Worksheet E-1b. On Worksheet X-4, please confirm no nursing fte’s for account 8750. . : - , Please consult your FHURS manual for further explanation and clarification of | ~. reporting requirement.. Modifications or corrections'to various accounts and Worksheet cell shall be made by resubmitting ‘the entire report using the FADES software and be retransmitted via . computer diskette. Please affix a label to the diskette with the following information. a) “Correction to Hospital FHURS Report , b) Hospital Name , c) Hospital Number (8 digit format) . ' . _ d) Reporting perio Cook . Work sie * which represents a progressive count of the number of ‘e@), “Submission Number ’ diskettes sent to the agency for this report. ; : on x — 1 SENDER: Hy . ; : | also wish to receive the follow- 1D Compjate Heme 1 andl 2 for actions! services. ; Ing services (for an extra fee): Print your name and address on the reverse of this form so that we can retum this card to you. D Attach this form fo the front of the maiipiece, or on the back if space does not 1. (] Addressée's Address 2. O Restricted Delivery permit. G White “Retum Receipt Requested’ on the mailpiece below the article number. OTs Return Receipt will show to whom ‘the article was delivered and the date 3. Afiicle Addressed to: completed on the reverse side? DO Express Maii Oinsured D Retum Receipt for Merchandise CICOD 7. Date of Delivery (2 (Only if requested and Thank you for using Return Recelpt Service, fee is paid) "Domestic Return Receipt fUUs USbuU UWUS Jou0 3U57 ' E so E Sauk . S gm: : FLORDA AGENCY FOR HEALTH CARE ADMINISTRATION = =: JEB BUSH, GOVERNOR : g B SECRETARY e =F CERTIFIED MAIL 2 R 7001 0360 003 3808 5059 5 Q . August 15, 2002 5 5 Jerry Kassab 5 9 Chief Executive Officer : 5 Lakeside Alternatives, Inc. : & 434 W. Kennedy Blvd. = ¥ g & Orlando, FL 32810 : ‘RE: 2001 Prior Year, Report AHCA#: 10-0129 Dear Mr. Kassab: ae OFS . as not received the audited financial statements at are . required to accompany the. annual filing of the prior year actual report in accordanéé with Rule 59E-5.201 (2)(d) F.A.C., for 2001. The audited financial statements were due in éur - office on October 28, 2001. On December 6, 2001, May 24, 2002, and July 10, 2002, the hospital was notified by certified letter of the deficiency existing with this filing requirement. w" Please be advised that the Agency h The inability of the hospital’s independent auditor to finish the audit prior to the required due date of the report is not, in and of itself, just cause for untimely filing pursuant to Rule S9E- _ 2.017 (5) F.A.C. : A ‘This is the last notification you will receive before an Administrative Complaint is filed ancial, statements. Section 408.08 of the against the hospital for failure to file the audited fin Florida Statutes provides that any hospital which refuses to file or fails to file a report when required by the Agency, shall be punished by a fine not to exceed $1,000 per day for each day it is late: You are granted an additional 10 (ten) working days from the date of receipt of this letter to have the audited. financial statements for 2001 received in our office to avoid legal action. cn ae oo a: fie . ‘ | = Cony ce: Sincerel ] Hem 41 sesininas Delivery 18 desu. | } ® Print your name and address on the reverse i so that we can return the card to you. = Artact this C card to the back of the mailpiece, or on nt if space i ; pace pemits. 4Qh-/2 D. ts delivery address different from item ~ / neem pakisde f D Yes fi .* YES, enter delivery address below: 0 No stopher J. Augsbur; / Lorngdnre > ! Regulatory Analyst et Side Hi 7760 t O S66 G0 SIgf i Ol Udy Me % 3. Service Type ‘Certified Mail ©) Express Mail Registered C Return Receipt for Merchandise 1A | i 5 - D insured Mat =O C.0.0. ( V4 i; , th L, FC 32 YO reid Delivery? (Extra Fee) D Ye | 2. Article Number! (Transfer from service lately i 2: i i EXHIBIT

Docket for Case No: 04-003468