Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: CLAY COUNTY MEDICAL INVESTORS, LLC, D/B/A LIFE CARE CENTER OF ORANGE PARK
Judges: P. MICHAEL RUFF
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Sep. 28, 2005
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, February 6, 2006.
Latest Update: Dec. 25, 2024
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Petitioner,
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CLAY COUNTY MEDICAL
INVESTORS, LLC, d/b/a LIFE
Case No. 2005004299
CARE CENTER OF ORANGE PARK,
Respondent.
O68 72
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ADMINISTRATIVE COMPLAINT
Petitioner, the Florida Agency for Health Care Administration (“AHCA”), through
undersigned counsel, files this Administrative Complaint against the above-named Respondent
1.
(“Respondent”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2003),' and alleges:
NATURE OF THE ACTION
This is an action to impose an administrative fine in the amount of $91,938 (the
“fine amount’) against Respondent, pursuant to Section 408.040, Florida Statutes, and Florida
Administrative Code Rules 59C-1.013 and 59C-1.021.
2.
For the calendar year 2003 (the “calendar year”), Respondent failed to comply
with the Medicaid condition, upon which its Certificate of Need (“CON”) was based, that a
minimum of 63% of its total annual days for its 180- bed facility shall be provided to Medicaid
Patients. See Exhibits A and B. Respondent further failed to timely report compliance with the
Page lof 11
CON condition that Respondent establish a 20-bed subacute care unit, which would include an
8-bed Respiratory Therapy Suite.
JURISDICTION AND VENUE
3. This tribunal has jurisdiction over Respondent pursuant to Sections 120.569 and
120.57, Florida Statutes, and Sections 408.031-408.045, Florida’s “Health Facility and Services
Development Act.”
4. Venue is determined by Florida Administrative Code Rule 28-106.207.
PARTIES
5. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1, Florida
Administrative Code, AHCA is the licensing and enforcing authority with regard to community
nursing home laws and rules.
6. Respondent is a corporation authorized under the laws of Florida to do business.
Respondent operates a community nursing home located at 2145 Kingsley Avenue, Orange
Park, Florida, 32703 and is the licensee on the CON issued on September 19, 1995, for the
construction of 60 beds in addition to the existing 120-bed community nursing home, with the
conditions that a minimum of 63% of its 180-bed facility’s total annual patient days shall be
provided to Medicaid patients, and that a 20-bed subacute care unit, including an 8-bed
Respiratory Therapy Suite, shall be established. The certificate of need number is 7737. See
Exhibit A.
‘Unless otherwise noted, all statutes and rules hereinafter cited are to the indicated year’s
Page 2of 11
COUNT I
(Respondent failed to meet its Medicaid condition)
Section 408.040, Florida Statutes
Florida Administrative Code Rule 59C-1.013
Florida Administrative Code Rule 59C-1.021
COUNT It
(Respondent failed to meet its subacute care unit condition)
Section 408.040, Florida Statutes
Florida Administrative Code Rule 59C-1.013
Florida Administrative Code Rule 59C-1.02
7. AHCA re-alleges paragraphs 1-6 above.
8. Respondent did not timely file annual compliance reports on the above CON.
9. Respondent failed to comply with the condition set forth in its CON, as required by
Section 408.040, Florida Statutes, and Rule 59C-1.013, Florida Administrative
Code, which provide, in part, as follows:
408.040 Conditions and monitoring
(1)(a) The agency may issue a certificate of need predicated upon statements of
intent expressed by an applicant in the application for a certificate of need. Any
conditions imposed on a certificate of need based on such statements of intent shall
be stated on the face of the certificate of need.
(b) The agency may consider, in addition to the other criteria specified in s.
408.035, a statement of intent by the applicant that a specified percentage of the
annual patient days at the facility will be utilized by patients eligible for care under
Title XIX of the Social Security Act. Any certificate of need issued to a nursing
home in reliance upon an applicant's statements that a specified percentage of
annual patient days will be utilized by residents eligible for care under Title XIX of
the Social Security Act must include a statement that such certification is a
condition of issuance of the certificate of need. The certificate-of-need program
shall notify the Medicaid program office and the Department of Elderly Affairs
when it imposes conditions as authorized in this paragraph in an area in which a
community diversion pilot project is implemented.
version of the statute or rule because this is the controlling year in question.
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(c) A certificate holder may apply to the agency for a modification of conditions
imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need
demonstrates good cause why the certificate should be modified, the agency shall
reissue the certificate of need with such modifications as may be appropriate. The
agency shall by rule define the factors constituting good cause for modification.
(d) If the holder of a certificate of need fails to comply with a condition upon
which the issuance of the certificate was predicated, the agency may assess an
administrative fine against the certificate holder in an amount not to exceed
31,000 per failure per day. In assessing the penalty, the agency shall take into
account as mitigation the relative lack of severity of a particular failure.
Proceeds of such penalties shall be deposited in the Public Medicaid Assistance
Trust Fund.
59C-1.013 Monitoring Procedures
(4) Reporting Requirements Subsequent to Licensure or Commencement of
Services. All holders of a certificate of need that was issued predicated upon
conditions expressed on the face of the certificate of need shall provide annual
compliance reports to the agency. The reporting period shall be January 1 through
December 31 of each year. The holder of a certificate of need who began operation
after January 1 will report from the date operation began through December 31. The
compliance report shall be submitted no later than April 1 of the subsequent year.
(a) The compliance report will contain information necessary for an assessment
of compliance with conditions on the certificate of need, utilizing measures, such as
a percentage of patient days, that are consistent with the stated condition. The
following information shall be provided in the holder’s annual compliance report:
1. The time period covered by the measures; 2. The measure for assessing
compliance with each of the conditions identified and described on the face of the
certificate of need; 3. The way in which the conditions were evaluated by applying
the measures; 4. The data sources used to generate information about the conditions
that were measured; 5. The person and position responsible for supplying the
compliance report; 6. Any other information necessary for the agency to determine
compliance with conditions; and 7. If applicable, the reason or reasons, with
supporting data, why the certificate of need holder was unable to meet the
conditions set forth on the face of the certificate of need.
(b) A change in the licensee for a facility or service does not affect the
obligation for that facility or service to continue to meet conditions imposed on a
certificate of need and to provide annual condition compliance reports.
(c) Conditions imposed on a certificate of need may be modified consistent with
Rule 59C-1.019, F.A.C.
(5) Violation of Certificate of Need Conditions. Health care providers found by
the agency to be in noncompliance with conditions set forth in their certificate of
need shall be fined as defined in Rule 59C-1.021, F.A.C.
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11.
10. The foregoing violation warrants imposition of the above-mentioned fine amount
pursuant to Florida Administrative Code Rule 59C-1.021, which provides, in part:
59C-1.021 Penalties.
(1) General Provisions. The agency shall initiate administrative proceedings for
revocation of a certificate of need for violation of paragraphs 408.040(2)(a) and (b),
F.S., or the assessment of administrative fines for failure to comply with conditions
placed on a certificate of need as specified under Rule 59C-1.013, F.A.C
* OF
(3) Penalties for Failure to Comply with Certificate of Need Conditions. The
agency shall review the annual compliance report submitted by the health care
providers who are licensed and operate the facilities or services and other pertinent
data to assess compliance with certificate of need conditions. Providers who are not
in compliance with certificate of need conditions shall be fined. For community
nursing homes or hospital-based skilled nursing units certified as such by Medicare,
the first compliance report on the status of conditions must be submitted 30 calendar
days following the eighteenth month of operation or the first month where an 85
percent occupancy is achieved, whichever comes first. The schedule of fines is as
follows:
(a) Facilities failing to comply with any conditions set forth on the Certificate of
Need will be assessed a fine, not to exceed $1,000 per failure per day. In assessing
the penalty the agency shall take into account the relative lack of severity of a
particular failure.
(b) The assessed fine shall be paid to the agency within 45 calendar days
after written notification of assessment by certified mail or within 30 calendar days
after final agency action if an administrative hearing has been requested. If a health
care provider desires it may remit payment according to a payment schedule
accepted by the agency. The health care provider must submit the schedule of
payments to the agency within 30 calendar days after the date of receipt of the
notification of assessment or 21 calendar days after final agency action. The final
balance will be due no later than 6 months after the health care provider has been
notified in writing by the agency of the amount of the assessed fine or 6 months
after final agency action.
AHCA, in determining the penalty imposed, considered the degree of non-
compliance and the relative lack of severity of a particular failure.
Page Sof 11
Co)
WHEREFORE, AHCA demands the following relief: (1) enter factual and legal
findings as set forth in these Counts; (2) impose the above-mentioned fine amount for the
violations; and (3) impose such other relief as this tribunal may find appropriate.
NOTICE
RESPONDENT is hereby notified that it has a right to request an administrative
hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative
action are set out in the attached Election of Rights (one page) and explained in the attached
Explanation of Rights (one page). All requests for hearing shall be made to the Agency for
Health Care Administration and delivered to the Agency for Health Care Administration, 2727
Mahan Dr., Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Clerk.
RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR
HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE
ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS
ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED.
Submitted as of the date indicated on the below Certificate of Service.
Qe Plante, o2 Attorney
Fla. Bar No. 966193
Agency for Health Care Administration
2727 Mahan Drive, Bldg. 3, MS #3
Tallahassee, Florida 32308
Phone: (850) 922-5873
Fax: (850) 921-0158 or 413-9313
Page 60f 11
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy of the original Administrative Complaint,
Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified
Mail, Return Receipt Requested (receipt# 7000 0600 0024 9206 3771) to Respondent,
Attention: Administrator, at the address stated in the above paragraph 6, this gay of
2005.
Donna La Plante, Senior Attorney
Page 7of 11
COMPLETE THIS SECTION ON DELIVERY
ENDER: COMPLETE THIS SECTION
| Complete Items 1, 2, and 3, Also complete
item 4 if Restricted Delivery is desired.
| Print your name and address on the reverse -- ---
so that we can return the card to you.
| Attach this card to the back of the mailpiece,
or on the front if space permits.
A. Signature
: pagan
Addresse
B. Received by ( Printed Name) C. Date of Deliver
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D. ts delivery address different from item 17 C1 Yes
W YES, enter delivery address below: a
Lite Care Centers
of AMErt aa
3520 Keith St. ,NW
»» box 2480
‘\eveland, “TN
371370 - 3480
| Article Number o
(Transfer from service label) OOD CO
S Form 3811, August 2001 Domestic Return Recelpt 102595-02-M-1£
3. Sepie ‘Type
Certified Mail! [J Express Mail
C1 Registered C Return Recelpt for Merchandis
O Insured Malt [1 C,0.0.
4. Restricted Delivery? (Extra Fee) 0 Yes
Docket for Case No: 05-003576
Issue Date |
Proceedings |
Feb. 06, 2006 |
Order Closing File. CASE CLOSED.
|
Jan. 27, 2006 |
Notice of Voluntary Dismissal and Motion to Relinquish Jurisdiction filed.
|
Nov. 21, 2005 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for February 13, 2006; 10:00 a.m.; Tallahassee, FL).
|
Nov. 14, 2005 |
Agreed Motion for Continuance filed.
|
Nov. 01, 2005 |
Order Granting Petitioner`s Motion to Amend Administrative Complaint.
|
Oct. 24, 2005 |
Motion to Amend Administrative Complaint filed.
|
Oct. 17, 2005 |
Notice of Hearing (hearing set for December 15, 2005; 10:00 a.m.; Tallahassee, FL).
|
Oct. 03, 2005 |
Response to Initial Order filed.
|
Sep. 29, 2005 |
Initial Order.
|
Sep. 28, 2005 |
Administrative Complaint filed.
|
Sep. 28, 2005 |
Petition for Formal Administrative Hearing filed.
|
Sep. 28, 2005 |
Election of Rights filed.
|
Sep. 28, 2005 |
Notice (of Agency referral) filed.
|