STATE OF FLORIDA Aaseey CLERK AGENCY FOR HEALTH CARE ADMINISTRATION a : 70s SEP 30 AT WOLFSDORF AND RASZYNSKI, MLD., P.A., - Petitioner, DOAH CASE NO. 04-4079MPI C.L NO. 95-0132-056 v. PROVIDER NO. 06300900 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, / FINAL ORDER THIS CAUSE concems a Petition for Formal Administrative Hearing that the Petitioner filed on October 12, 2004. On November 10, 2004, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge. The Petitioner was also a party to a Rule Challenge that was filed on January 13, 2005, in DOAH Case No. 05-0092RX, which contested the validity of the Agency’s critical care rule contained in the Agency handbook that was in effect during the audit period in this case, and that was applied to determine the overpayment alleged in the Final Agency Audit Letter GRAAL) that was issued in this case. Based on the rule challenge, the Agency revised its critical care rule, and, following the final adoption of the handbook containing the revised critical care rule, the rule challenge was later voluntarily dismissed with prejudice on August 25, 2005. On January 28, 2005, the Administrative Law Judge assigned to this case issued an Order Granting Continuance and Placing Case In Abeyance, and, on April 8, 2005, the Administrative \ i tb Law Judge assigned to this case issued an Order Continuing Case In Abeyance. On August 30, 2005, the parties filed a Joint Motion to Remand Case to the Agency for Health Care Administration in which the parties advised the Division that the Agency had adopted a handbook containing a critical care rule revised to be in compliance with federal law that effectively negated the overpayment alleged in this case. The Joint Motion advised that, had the revised critical care rule been applied, there would have been no overpayment alleged against Petitioner in this case. The Joint Motion operated as a rescission by the Agency of the FAAL issued in this case, along with an agreement by the Agency that it would not re-issue another FAAL alleging any overpayment for the audit period in question. The Joint Notice further provided that each of the parties would bear its respective attorney’s fees and costs. On September 1, 2005; the Administrative Law Judge assigned to this case issued an Order Closing File based on the parties’ representation that the adoption by the Agency of a handbook containing a critical care rule revised to be in compliance with federal law would have the effect of negating the overpayment alleged in this case. IT IS THEREFORE ORDERED AND ADJUDGED THAT: - The FAAL issued by the Agency in this case is hereby rescinded; - The Agency shall not issue another FAAL alleging any overpayment for the audit period in question; - Each party shall bear its own attorney’s fees and costs associated with this case; and - This case is now closed. att DONE and ORDERED this 26 day of _ 5675-7 HG7E—__, 2005, in Tallahassee, Florida. fit e be YZEs FA fn ALAN LEVINE, Secretary AGENCY FOR HEALTH CARE ADMINISTRATION NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail io the persons named below on this Scie day of Sprhefer—, 2005. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Stuart M. Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Donna Riselli, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 Gary J. Clarke, Esquire Sternstein, Rainer & Clark 411 East College Avenue Tallahassee, Florida 32301 Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS#4 Fort Knox Building IIT Tallahassee, Florida 32308 STATE OF FLORIDA ere DIVISION OF ADMINISTRATIVE HEARINGS 95 Jay 27 py . ; . R 5 Ul Vi 31 aE ADMINig ys u WOLFSDORF & RASZYNSKI, HEARINGS Yt MLD., P.A. Petitioner, VS. DOAH Case No.: 04-4079MPI AGENCY FOR HEALTH CARE GENERAL COUNSEL ADMINISTRATION, JAN 27 2005 Respondent. Agency for Health / — . Care Administration MOTION TO HOLD CASE IN ABEYANCE Petitioner WOLFSDORF & RASZYNSKI, M.D., P.A., by and through its undersigned counsel, hereby files this motion to hold this case in abeyance, and as justification states as follows. 1. The essential nature of this case, as alleged in Respondent’s Final Agency Audit Letter, is whether or not Petitioner filed certain claims for “critical care services” in accordance with Respondent’s Physician Services Coverage and Limitations Handbook. This Handbook has been incorporated by reference into the rules of the Agency, at 59G-4.230, F.A.C. 2 As a part of its defense in this case, Petitioner has asserted that the part of the Rule (i.¢., the Handbook) the Respondent Agency relies on is fundamentally flawed, in that it is contrary to federal law on the subject, and is not authorized by state law. 3. As a result, Petitioner has joined in a rule challenge petition, with two other physicians, to challenge the rules in question. The rule challenge case is Wolfsdorf and Raszynski. M.D., P.A.: Alberto Marante, M.D.: and Anwar M. Vardag, M.D. vs. Agency for Health Care Administration, Case No. 05-0092RX. 4. Though Petitioner asserts other defenses in this case, including the Statute of Limitations, it is believed that resolution of the rule challenge case in a manner that is favorable to Petitioners will result in an amicable settlement of this case and dismissal by the parties. 5. The nearly identical nature of two other related cases — Alberto Marante vs. Anwar M. Vardag, M.D. vs. Agency for Health Care Administration, Case No.: 04-4629 MPI ; and Agency for Health Care Administration, Case No.:04-4624MPI — and the common issues of law and fact, indicate that judicial economy and efficiency would be served, and amore uniform result would be promoted, if this (and the other cases noted above) were held in abeyance, pending the outcome of the rule challenge case. 5. Counsel for Petitioner in this case is the same person as in the rule challenge case and the related cases noted above. He will be filing similar motions in all these cases. 6. Counsel for the Respondent Agency in this case is the same person representing the Agency in the rule challenge case, and the other related cases. She has been consulted regarding this matter, and indicates she supports this motion. 7. In the event the Court does not grant this motion, then Counsel for Petitioner moves for a Continuance in this particular case. As cause therefore, Counsel for Respondent recently experienced the death ofa close family member, and has missed (and will miss) considerable work due to end-of-life family issues. Counsel for Respondent has been consulted on this alternative motion, and has indicated her agreement with it. RESPECTFULLY SUBMITTED this # 7 “day of January, 2005 STERNSTEIN, RAINER & CLARKE Gary J. , Florida Bar # 864498 Frank P er, Florida Bar # 436518 STERNSTEIN, RAINER & CLARKE 411 E. College Ave. Tallahassee, FL 32301 (850) 577-6557; ext. 14 FAX (850) 577-6599 Counsel for WOLFSDORF & RASZYNSKI, M.D., P.A. CERTIFICATE OF SERVICE I CERTIFY that an original and one copy of the foregoing REQUEST FOR ADMISSIONS has been furnished to the following: Donna Riselli, Esq. Assistant General Counsel and Richard Shoop, Esq. Agency Clerk Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, 3" Floor Tallahassee, Florida 32399 by hand-delivery on this 4 7 & day of January, 2005. Y eh Gary/J. Cl

Docket for Case No: 04-004079MPI