STATE OF FLORIDA : _ AGENCY FOR HEALTH CARE ADMINISTRATION’ 21°"! 07 © 4 COMBINED HEALTH SERVICES d/b/a UNIVERSAL ARTS PHARMACY, eS Petitioner, vane a ar Q CASE NO. 05-0875MPI ‘= an PROVIDER NO. 021852900 *° AUDIT C.I. NO. 01-1468-000 Rendition No. AHCA-05-_ -S-MDP. vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. _ DONE and ORDERED on this the JO day of TYPE: , 2005, in Tallahassee, Florida. je’ #lan 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: Karen Dexter, Esquire Agency for Health Care Administration (Interoffice Mail) William M. Furlow, Esquire Akerman Senterfitt 106 E. College Avenue, Suite 1200 Tallahassee, Florida 32301 (U.S. Mail) Errol] Powell Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Kathy Heroldyffedicaia Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE 1 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 “S day Te , 2005. of ee Richard Shoop, Esquire Agency Clerk 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 COMBINED HEALTH SERVICES d/bla UNIVERSAL ARTS PHARMACY, Petitioner, vs. CASE NO. 05-0875MP1 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Combined Health Services d/b/a Universal Arts Pharmacy (“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 021852900 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated December 3, 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 e to the audit letter dated December 3, overpayment, in the amount of $15,744.38. In respons: 2004, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 05-0875MPI. ’ Universal Arts Pharmacy C.1. 01-1463-000 Settlement Agreement 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: @) (2) (3) (4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of entry of the final order, PROVIDER agrees to pay the Agency the sum of fifteen thousand seven hundred forty-four dollars and thirty-eight cents ($15,744.38) plus 10% interest per year to be made in three (3) equal consecutive monthly payments in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 05-0875). AHCA retains the right to perform a 6-month follow-up review. 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.]. 01-1468- 000. 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. 5 Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Universal Arts Pharmacy C.!. 01-1468-000 Settlement Agreement 6. 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. 7. ABCA 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees and costs, if any. 10, 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. 11. 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. 12. 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. ) Universal Arts Pharmacy C.J. 01-1468-000 Settlement Agreement 13. 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 jaw, 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. 14. 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. 15. 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. 16. 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. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. ” Universal Arts Pharmacy C.1. 01-1468-000 Settlement Agreement 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. COMBINED HEALTH SERVICES d/b/a UNIVERSAL ARTS PHARMACY Ag? 7A , / nae he Mere Dated: LIAY , 3 , 2005 py. AbFetde C movlne (Print name) ITS: AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Z >- Bod Dated: 6S a ____, 2005 James D. Boyd Inspector General ; 7. — _ eM libs Aine Dated: 8 Le 2@ , 2005 William Roberts Acting General Counsel Dated: W/L7 Lh , 2005 Assistant General Counsel

Docket for Case No: 05-000875MPI