STATE OF FLORIDA A DIVISION OF ADMINISTRATIVE HEARINGS OOS, OCT - By | SOUTH BEACH COMMUNITY & = HOSPITAL, LLC, S - o Petitioner, ‘ — Ti U vs. CASE NO. 05-2881MPI = Audit No.: CI 05-2883-0002 AGENCY FOR HEALTH CARE Provider No.: 010059500 ADMINISTRATION, Respondent. / FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. In a letter dated May 17, 2005, South Beach Community Hospital, LLC (Respondent) was informed that the State of Florida, Agency for Health Care Administration (Agency) was seeking to recoup Medicaid overpayments in the amount of $178,811.34. The letter was sent Certified Mail, return receipt requested, to Respondent. The letter contained full disclosure and notice regarding Respondent’s administrative hearing and due process rights. Respondent requested a formal administrative hearing to dispute the facts contained in the letter. The matter was referred to the Division of Administrative Hearings and was assigned case number 05-2881MPI. Case # 05-2881MPI South Beach Community Hospital, LLC Respondent, South Beach Community Hospital, filed a Notice of Voluntary Dismissal of Petition for Administrative Hearing on August 31, 2005. Subsequently, the Administrative Law Judge issued an Order Closing File on September’ 1, 2005. The Final Agency Audit Report that was issued by the Agency on May 17, 2005, is still in effect and the overpayment in the amount of $178,811.34 is still owed to the Agency. Based on the foregoing: IT IS THEREFORE ORDERED AND ADJUDGED THAT: The request for a hearing is dismissed and the overpayment of $178,811.34 is due to the Agency. Unless payment has already been made, payment in full of $178,811.34, plus statutory interest is now due from the respondent as a result of the agency action. Such payment shall be made in full within 30 days of the filing of this Final Order of Dismissal With Prejudice. The payment shall be made by check payable to Agency for Health Care Administration, and shall be mailed to the Agency for Health Care Administration, Office of Finance and Accounting, Attn. Jean Lombardi, 2727 Mahan Drive, Fort Knox Building 2, Mail Stop 14, Tallahassee, Florida 32308. DONE and ORDERED on SLIT HEFL 2-6 , 2005, in Tallahassee, Florida. gE ¢ Agency for Health Care Administration Case # 05-288 1MPI South Beach Community Hospital, LLC 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: Debora E. Fridie Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Felicia Leborgne Nowels Akerman Senterfitt 106 East College Avenue, Suite 1200 Tallahassee, Florida 32301 (U.S. Mail) John G. Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Medicaid Program Integrity Finance & Accounting Case # 05-2881MPI ° South Beach Community Hospitel, LLC 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 Ondber Ss , 2005. 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

Docket for Case No: 05-002881MPI