STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION PROVIDENCE PROPERTY AND CASUALTY INSURANCE COMPANY, DALLAS FIRE INSURANCE COMPANY and AMS STAFF LEASING, INC., Petitioners, DOAH CASE NO. 05-4517 AHCA NO. 2005009496 v. ; BMHC CASE ID 20050908-005 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION and HOLMES REGIONAL MEDICAL CENTER, INC., Respondents. FINAL ORDER THIS CAUSE concerns an Amended Petition for Formal Administrative Hearing (“Petition”) that the Petitioners filed on November 28, 2005. On December 12, 2005, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On February 3, 2006, the Petitioner filed a Notice of Voluntary Dismissal with Prejudice, stating that the Petitioners had agreed to pay the disputed bill at the rate specified by the Agency in its October 7, 2005 determination. 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, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioners’ Petition is dismissed with prejudice and the Agency’s October 7, 2005 Determination is hereby upheld. Unless they have already done so, Petitioners shail submit the correct reimbursement amount as stated in the Agency’s October 7, 2005 Determination to Holmes Regional Medical Center, Inc. within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Donna Reynolds, R.N., AHCA WC Med Services, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, Florida 32399-4229. Petitioners shall govern themselves accordingly. DONE and ORDERED this €A day of Capt , 2008, in Tallahassee, Florida. 2 ede ucdete HOLLY BENSON, Secretary AGENCY FOR HEALTH CARE ADMINIS TION 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 furnished by U.S. or interoffice mail to the persons named below on this ZB day of Apc _. 2008. =<