STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION jen, Oy Ay MANAGED HEALTHCARE SYSTEMS, ING., en oy Petitioner, vs. CASE NO. 05-2439MP¥p¢%, ©? JUDGE: Patricia M. Hark//4.75-. AGENCY FOR HEALTH CARE C.I. NO. 02-0378-000-3 F878" or. ADMINISTRATION, Cries Le Respondent. aan / 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 al “ay of STV EYEE <<, 2006, in Tallahassee, Florida. ae, ao y (ri ehtista Calamas, Secretary Agency for Health Care Administration 4 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: Jeffries H. Duvall, Esquire Agency for Health Care Administration (Interoffice Mail) Mark Pomeranz, Esq. Pomeranz & Associates, P.A. 12955 Biscayne Blvd.; Suite 202 North Miami, FL 33181 (U.S. Mail) The Honorable Patricia M. Hart Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity, MS 6 Agency for Health Care Administration (Interoffice Mail) James Boyd, Inspector General, MS 4 Agency for Health Care Administration (Interoffice Mail) Finance and Accounting, MS 14 Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE | 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 ZE™ day of ee er , 2006. Richard Shoop, Esquire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 (850) 922-5873 phone (850) 921-0158 fax 28h SEP 27 AIL 2b STATE OF FLORIDA DE eISION OF DIVISION OF ADMINISTRATIVE HEARINGS a 7:4 fiSTRATIVE HEARINGS MANAGED HEALTHCARE SYSTEMS, INC., Petitioner, vs. Case No. 05-2439MPT CAL No: 02-0378-44H)-3 Provider No.: 1054244 00 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ; / SETILEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, (AHCA" or “the Agency”), and MANAGED HEALTHCARE SYSTEMS, INC., (PROVIDER"), by and through the undersigned, hereby stipulate and agtee as follows: 1. This Agreement is entered into for the purpose of memorializing the final resolution of the matters set forth in this Apreement. 2, PROVIDER is a Medicaid provider itt the State of Florida, provider rumber 1054244 00 and was a provider during the audit petiod. 3. In its final agency audit teport (final agency action) dated May 10, 2005, AHCA notified PROVIDER that teview of Medicaid claims performed by Medicaid Program Integrity (MPD), Office of the Ittspector General, indicated that certain claims, it whole or in part, wete not covered by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $519,683.61. In response to the audit letter dated May 10, 2005. PROVIDER filed a petition for a formal administrative heating. which was assigned DOAH Case No. 05-2439 MPt. \20-d 20/€0'd = 890-1 “Hous = Wd82:21 80-20-Tn 4. Subsequent to filing the Petition for formal heating. PROVIDER submitted Further documentation for review. A portion of the prescriptions and refills that had been at issue were resolved. It is agreed by the patties that the actual overpayment is $74,163.05. 5. AHCA and the PROVIDER agree that the underlying facts of this matter show the integrity of the Medicaid program is best preserved by the resolution specified in paragraph 6 below. 6. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA exptessly spree as follows: (A) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (B) AHCA has incurred certain costs in relation to the audit and prosecution of this matter and Providet agrees to pay $3,336.95 towards these costs. (C) — Within thirty days of issuance of the final order, PROVIDER shall pay AHCA seventy-seven thousand five bundred and no/100 dollars ($77,500.00) in full and complete settlement of all claints in the proceedings before the Division of Administrative Hearings (DOAH Case No. 05-2439 MPN, (D) . AHCA agrees to accept the paythent set forth herein in settlement of the Overpaymertit issttes arising from the MPT review. (E) PROVIDER and AHCA agtee that full payment as set forth above will resolve atid settle this case completely and release both parties frorn all liabitities arising from the findings in the audit referenced as C1. No. 02-0378-000-3. (F) PROVIDER agrees that it will not rebill the Medicaid Program in any inanner for claitns that were not covered by Medicaid, which are the subject of the audit in this case. 12O-4d20/%0'd = 890-1 Hod = Ad22t21 90-20-T0r 7. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 8. PROVIDER agrees that failure to pay any monies duc and owing under the terms of this Agreement shall cause the entire uttpaid principal and interest to become due and owing and shall constitute PROVIDER'S authorization for the Agency, without further hotice, to withhold the total remaining amount due under the terms of this agreement from any monties due and owing to PROVIDER for any Medicaid claims to authorize AHCA to pursue any other remedy under Florida law. 9. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Progtam, and all other applicable rules and repulations, 10. This settlement does not constitute an admission of wrougdoing or ettor by either party with respect to this case or any other matter. 11. Each party shall bear its own attorneys’ fees atid costs, if any, except as set forth herein, 12. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authotized to enter into this Agreement on behalf of the respective parties. 13. This Agreement shall be construed in accordance with the provisions ofthe laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida, 14. ‘This Agreement constitutes the entire agreement between PROVIDER and the AHCA, including anyoue acting for, associated with or employed by them, concerning all _ tatters atid supersedes any prior discussiotis, agreements or understandings; there are no promises, representations or agreeruents 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 Apreement is completed and properly executed by the parties. 15. This is an Agreement of settlement, made in recognition that the parties may have different or incorrect understanditigs, information and coftteritions, as to facts and law, and with each party waiving all objection to any potential correcttiess or incottectness of its viderstandings, information and contentions as to facts and law, so that no misundetstanding or misinformation shall be a ground for rescission hereof. (20-4 20/90'd = 880-1 “WOU = Add2*2t 90-20-10 16. 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 atid all issues raised herein. PROVIDER further agrees that it shall not challenye ot contest any Final Order entered in this piatter which is consistent with the tetms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative procceding, circuit or federal court action or any appeal. 17. This Agreement is and shall be deemed jointly drafted and written by all patties to it and shall not be construed or interpreted against the party originating or preparing it. 18. To the extent that any provision of this Agreement is prohibited by law for any teason, such provision shall be effective to the extettt not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 19. This Agreervent shall inure to the benefit of and be binding on each party's successors, assigns, heits, administrators, representatives and trustees. 20. All titnes stated herein are of the essence of this Agreement. 21. This Agreement sball be in full fotce and effect upon execution by the respective parties in counterpart. 22. ‘The provider agrees to cooperate in and cottsent to comprehensive follow-up teviews of the provider every 6 months as required by Section 409.913, Florida Statutes, to ensure that they are billing Medicaid correctly, SYSTEMS, INC. Yl Dated: , 2006 Dated: » 2006 Attomey for Petitioner (20-4 20/90'd = 890-1 Wods = WdB2:Z1 80-20-7010 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 zt ; huerses be Dated: 7- Dated: FLU , 2006 William H.-Roberts. Acting General’ Counsel WéO-4 = -20/20'd = 890-1 “WONS = WdB2271 9O~L0-TNr

Docket for Case No: 05-002439MPI