STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2608 JUN 17 TBR b DALLAS FIRE INSURANCE COMPANY, PROVIDENCE PROPERTY AND CASUALTY INSURANCE COMPANY AND AMS STAFF LEASING, INC., Petitioners, ; DOAH CASE NO. 05-4434 AHCA NO. 2005009303 v. DETERMINATION NO. 2005010-006 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THIS CAUSE concerns an Amended Petition for Formal Administrative Hearing (“Petition”) that the Petitioners filed on November 29, 2005. On December 6, 2005, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On February 6, 2006, the Petitioners filed a Notice of Voluntary Dismissal with Prejudice, stating that the Petitioners agreed to pay the disputed bill. On February 6, 2006, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, AAG Sb IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioners’ Petition is dismissed with prejudice and the Agency’s September 30, 2005, Determination is hereby upheld. Unless they have already done so, Petitioners shall submit the correct reimbursement amount as stated in the Agency’s September 30, 2005, Determination to The Gables Surgical Center within 30 days of the date that this final order is tendered, and shall submit proof of reimbursement to: Ms, Twan Jackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this B day of Cheae_ , 2008, in Tallahassee, HOLLY BENSON, Secretary AGENCY FOR HEALTH CARE ADMINISTRATION NOTICE OF RIGHT TO JUDICIAL REVIEW EEE SUDICIAL REVIEW CERTIFICATE OF SERVICE T HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this & day of Coarse , 2008. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Daniel Manry Mari H. McCully, Esquire Administrative Law Judge Department of Financial Services Division of Administrative Hearings Division of Worker’s Compensation The DeSoto Building 200 East Gaines Street 1230 Apalachee Parkway Tallahassee, Florida 32399-4229 Tallahassee, Florida 32399-3060 Gail A. Lane, Esquire Jan Mills AMS Staff Leasing Facilities Intake Legal Department | 14160 Dallas Parkway, Suite 500 Dallas, Texas 75254 George F. Indest, II, Esquire Elizabeth Dudek Joanne Kenna, Esquire Health Quality Assurance The Health Law Firm 220 East Central Parkway, Suite 2030 Altamonte Springs, Florida 32701 Miguel Maldonado The Gables Surgical Center 150 Southwest 12" Avenue, Suite 201 Pompano Beach, Florida 33069

Docket for Case No: 05-004434