STATE OF FLORIDA E HH Le P- AGENCY FOR HEALTH CARE ADMINISTRATION aid AD AWAD Ags ay i) A 1 Sb PROVIDENCE PROPERTY AND IiSIOH oF CASUALTY INSURANCE COMPANY, ADH HNISTRATIVE DALLAS FIRE INSURANCE COMPANY, HEARINGS AND AMS STAFF LEASING, INC., Petitioners, DOAH CASE NO, 05-4516 AHCA NO. 2005008863 v. DETERMINATION NO. 20050825-043 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THIS CAUSE concerns a Second Amended Petition for Formal Administrative Hearing (“Petition”) that the Petitioners filed on December 1, 2005. On December 9, 2005, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On February 10, 2006, the Petitioners filed a Notice of Voluntary Dismissal with Prejudice, stating that the Petitioners agreed to pay the disputed bill. On February 10, 2006, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioners’ Petition is dismissed with prejudice and the Agency’s September 13, 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 13, 2005, Determination to Tenet Regional Business Office/Palmetto General Hospital within 30 days of the date that this final order is rendered, 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 / day of fins , 2008, in Tallahassee, Florida. HOLLY BENSQN, Secretary AGENCY FOR HEALTH CARE ADMINISTRATION NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been : 7 ae furnished by U.S. or interoffice mail to the persons named below on this 46 day of ¢ Ye —— , 2008. = aa 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 Administrative Law Judge Division of Administrative Hearings Mari H. McCully, Esquire Department of Financial Services 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, HI, Esquire Elizabeth Dudek Haseeb R. Jabbar, Esquire Health Quality Assurance The Health Law Firm 220 East Central Parkway, Suite 2030 Altamonte Springs, Florida 32701 Joseph W. May, Esquire Bacen & Jordan, P.A. 2699 Stirling Road, Suite A302 Ft. Lauderdale, Florida 33312

Docket for Case No: 05-004516