STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATIONnns Me MEDICAL PROFESSIONALS OF MIAMI, 22 S INC., am . Petitioner, vs. CASE NO. 05-0697MPI PROVIDER NO. 054678002 STATE OF FLORIDA, AUDIT C.I. NO. 00-1550-000 AGENCY FOR HEALTH CARE Rendition No. AHCA-05- = -5-MDP ADMINISTRATION, rn Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement “Wy Agreement. The parties are directed to comply with the terms of the attached U settlement agreement. Based on the foregoing, this file is s CLOSED. DONE and ORDERED on this the LE bey of ALKGg4Age—_, 2005, in Tallahassee, Florida. a inal 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: L. William Porter I, Esquire Agency for Health Care Administration (Interoffice Mail) Bernard P. Coniff, Esquire 600 W. 20% Street Hialeah, Florida 33010 (U.S. Mail) ‘ Claude Arrington Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Billo Jolly, Meflicaid Program Integrity John Hoover, Finance and 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 (Say of fer, 2005. Richard Shoop, Esquire Agency Clerk 1 7 State of Florida . Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 : _ STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS MEDICAL PROFESSIONALS OF MIAMI, INC., Petitioner, vs. ‘ CASE NO. 05-0697MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Medical Professionals of Miami, 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, provider number 054678002 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated November 19, 2004, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), Office of the AHCA Inspector General, indicated that certain claims, in whole or in part, has been inappropriately paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $54,253.91. In response to the audit letter dated November 19, Medical Professionals of Miami, Inc. Settlement Agreement 2004, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 05-0697. 4, Subsequent to the original audit that took place in this matter and in preparation for trial, ACA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the overpayment was adjusted to $50,347.73. 5, Jn order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: re @) (2) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. PROVIDER agrees to pay the Agency fifty thousand three hundred forty seven dollars and seventy three cents ($50,347.73) plus one thousand dollars ($1,000) in investigative costs, for a total of fifty one thousand . three hundred forty seven dollars and seventy three cents ($51,347.73). The PROVIDER will make an initial payment of fifteen thousand dollars ($15,000.00) within thirty days of entry of the final order, and the balance of thirty six thousand three hundred forty seven dollars and seventy three cents ($36,347.73) plus 10% interest, within 180 days of entry of the final order, in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case’ No. 05- 0697). AHCA retains the right to perform a 6 month follow-up review. Medical Professionals of Miami, Jnc. Setilement Agreement (3) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.I. 00-1550- 000. (4) 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. 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. 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. ) 8. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 10. Each party shall bear its own attomeys’ fees and costs, if any. 11. 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. 12. 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. Medical Professionals of Miami, Inc. Settlement Agreement 13., 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. 14. 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. 15. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 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 it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. This 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. Medical Professionals of Miami, Jnc. Settlement Agreement 17. To the extent that any provision of this 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 Agreement. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. . MEDICAL PROFESSIONALS OF MIAMI, INC. J "bed Drees Dated: 4/2 z , 2005 BY: witFRé0 GARCERAS (Print name) ims: feéS Mle 7_ AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: eum AeE /k , 2005 es D. Boyd Inspector General C hu A, >B, , $23.13875000 wl ial 1 = 1 value from the Distribution of t Table, 1.6991268 All of the claims relating to a recipient represent a cluster. Aj is the overpayment relating to the ith recipiént in the sample, and B; is the number of claims relating to the ith recipient in the sample, The values of overpayment and number of claims respecting each recipient in the sample are shown on the accompanying schedule. From this statistical formula, which is geherally accepted for this purpose, we have calculated that the overpayment to you is $54,253.91 with a ninety-five percent (95%) probability that it is that amount or more. If you are currently involved in a bankruptcy, you should notify your attorney immediately and provide them with a copy of this letter. Please advise your attorney that we need the following information immediately: (1) the date of filing of the bankruptcy petition, (2) the case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida. Tallahassee Division); and, (4) the name, address, and telephone number of your attomey.""""" If you are not in bankruptcy and you concur with our findings, remit by check in the amount of $54,253.91. The check must be payable to the Florida Agency for Health Care : Administration. Questions regarding payment should be directed to Medicaid Accounts Receivable, (850) 488-5869. To ensure proper credit, be certain your provider number and the audit number (beginning with C.1.) are shown on your check. Please mail to: Agency for Health Care Administration . Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32317-3749 If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(27), F.§. Furthermore, pursuant to Sections 409.913(25) and 409.913(15), F.S., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may. result in termination from the Medicaid Program. You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. Ifa request for a formal hearing is made, the petition must be made in compliance with Section 28- 106.201, Florida Administrative Code (F.A.C.) and mediation may be available. Ifa request for an informa! hearing is made, the petition must be made in compliance with rule Section 28- 106.301, F.A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this letter. Med Professionals of Hialeah Page 4 For more information regarding your hearing and mediation rights, please see the attached Notice of Hearing and Mediation Rights. ‘ Questions should be directed to: Bonnie Mills-Herrera, Medical/Health Care Program Analyst, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, P.O. Box 53-2804, Miami, Florida 33152-2804, telephone (305) 470- 5862. Sincerely. degen forte Magda Resales AHCA Administrator MNR/BMH/def Attachment cc: Medicaid Accounts Receivable cen ps A Med Professionals of Hialeah Page 5 NOTICE.OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the right to request an administrative hearing pursuant to Sections 120.569 and 120,57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Agency ort (hereinafter FAAR), you may request a formal administrative hearing pursuant to Section 120.57(1), Florida Statutes. If you do not dispute the facts stated in the FAAR, but believe there are additional reasons to grant the relief you seek, you may request an informal administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section 120.573, Florida Statutes, mediation may be available if you have chosen a formal ‘ . The written request for an administrative hearing must conform to the requirements of either Rule 28-106.201(2) or Rule 28-1 06.301(2), Florida Administrative Code, and must be received by the Assistant Bureau Chief by 5:00 P.M. no later than 21 days after you received the Agency for Health Care Administration to, 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 The request must be legible, on 8 % by 11-inch white paper, and contain: 1. Your name, address, telephone number, any Agency identifying number on the FAAR, if known, and name, address, and telephone number of your representative, if any; 9, An explanation of how your substantial interests will be affected by the action described inthe FAAR; _..A statement of when and how you received the FAAR; _ Fora request for formal hearing, a statement of all disputed issues of material fact; . Fora request for formal hearing, a concise statement of the ultimate facts alleged, as well _as the rules and statutes which entitle you to relief; For a request for formal hearing, whether you request mediation, if it is available; ” For a request for informal hearing, what basis supports an adjustment to the amount owed to the Agency; and . Ademand for relief. Oo ND WPL A formal hearing will be held if there are disputed issues of material fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a neutral third party to assist the parties in a legal or administrative proceeding to reach a settlement of their case. If you and the Agency agree to mediation, it does not mean that you give up the right to a hearing. Rather, you and the Agency will try to settle your case first with mediation. If you request mediation, and the Agency agrees to it, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement. If a mediation agreement is not reached within 10 days following the request for mediation, the matter will proceed without mediation. The mediation must be concluded within 60 days of having entered into the agreement, unless you and the Agency agree to a different time period. The mediation agreement between you and the Agency will include provisions for selecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shared equally by you and the Agency. {fa written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set forth in the FAAR shall be conclusive and final.

Docket for Case No: 05-000697MPI

Issue Date	Proceedings
Nov. 28, 2005	Final Order filed.
Jul. 28, 2005	Order Closing File. CASE CLOSED.
Jul. 25, 2005	Joint and Agreed Motion to Continue the Final Hearing for 60 days filed.
Jun. 24, 2005	Order Granting Continuance and Re-scheduling Hearing (hearing set for August 16 and 17, 2005; 9:00 a.m.; Miami, FL).
Jun. 24, 2005	Agreed Motion for Continuance filed.
Jun. 03, 2005	Letter to L. Porter from L. Medez regarding the subpoena received for June 6, 2005 filed.
May 18, 2005	Re-notice of Deposition filed.
Apr. 29, 2005	Amended Notice of Deposition filed.
Apr. 25, 2005	Notice of Deposition filed.
Apr. 18, 2005	Order Granting Continuance and Re-scheduling Hearing (hearing set for July 11 and 12, 2005; 10:30 a.m.; Miami, FL).
Apr. 11, 2005	Amended Notice of Hearing (hearing set for April 21 and 22, 2005; 9:00 a.m.; Miami, FL; amended as to location).
Apr. 11, 2005	Unopposed Motion for Continuance filed.
Apr. 04, 2005	Motion for Hearing to be by Video Teleconference filed.
Mar. 10, 2005	Notice of Service of Interrogatories, First Interrogatories, Request for Admissions & Request for Production of Documents filed.
Mar. 08, 2005	Order of Pre-hearing Instructions.
Mar. 08, 2005	Notice of Hearing (hearing set for April 21 and 22, 2005; 9:00 a.m.; Tallahassee, FL).
Mar. 04, 2005	Initial Order Report filed.
Mar. 03, 2005	Unilateral Response to Initial Order filed.
Feb. 24, 2005	Initial Order.
Feb. 23, 2005	Final Agency Audit Report filed.
Feb. 23, 2005	Request for Formal Hearing filed.
Feb. 23, 2005	Notice (of Agency referral) filed.