Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: MEDICAL DIAGNOSTIC LABORATORIES, LLC
Judges: ELLA JANE P. DAVIS
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Mar. 03, 2006
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, September 8, 2006.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA EY Pot an
DIVISION OF ADMINISTRATIVE HEARINGS : LHP g3
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner,
vs. CASE NO. 06-0790MPI
AUDIT C.1. NO. 06-3985-000
MEDICAL DIAGNOSTIC PROVIDER NO. 030726200
LABORATORIES, LLC,
RENDITION NO.: AHCA-06-2 du:@ -S-MDO
Respondent.
/
FINAL ORDER
THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The
parties are directed to comply with the terms of the attached settlement agreement. Based on the
foregoing, this file is CLOSED.
,
DONE and ORDERED on this the 5-5 day of _ screws. _, 2006, in
Tallahassee, Florida.
fo Christa Calamas, Secrétary
Agency for Health Care Administration
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:
L. William Porter Il, Esquire
Agency for Health Care
Administration
(Interoffice Mail)
Jeffrey J. Sherrin, Esquire
O’Connell and Aronowitz, P.C.
54 State Street
Albany, New York 12207
(U.S. Mail)
E.J. Davis
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Tim Byrnes, Chief, Medicaid Program Integrity
Jill Smith, Medicaid Program Integrity
Maryann Alliegood, Finance and Accounting
CERTIFICATE OF SERVICE
T HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to
the above named addressees by U.S. Mail on this the DSi tay of C tthe y~_, 2006.
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
STATE OF FLORIDA ie a i ma ry
DIVISION OF ADMINISTRATIVE HEARINGS oben
STATE OF FLORIDA, 7th OCT 27 Aik 18
AGENCY FOR HEALTH CARE ASIOR OF
ADMINISTRATION, GIVES
ADMINISTRATIVE
Petitioner, HEARINGS
vs. CASE NO. 06-0790MPI
CILNO. 06-3985-000
MEDICAL DIAGNOSTIC
LABORATORIES, LLC,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and Medical Diagnostic Laboratories, LLC (“PROVIDER”), by and
through the undersigned, hereby stipulate and agree as follows:
1, The two parties enter into this agreement for the purpose of memorializing the
resolution to this matter.
2. PROVIDER is a Medicaid provider in the State of Florida, provider number
030726200 and was a provider during the audit period.
3. In its Final Agency Audit Report (final agency action) dated January 13, 2006,
AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program
Integrity (MPI), Office of the AHCA Inspector General, indicated that certain claims, in whole
or in part, had been inappropriately paid by Medicaid. The Agency sought recoupment of this
overpayment in the amount of $645,509.79. In response to the January 13, 2006 audit letter,
PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No.
06-0790.
Medical Diagnostic Laboratories, LLC
Settlement Agreement
4, Subsequent to the original audit and in preparation for trial, AHCA re-reviewed
the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER.
As a result of the additional review, AHCA determined the overpayment should be adjusted to
$169,838.68.
5. In order to resolve this matter without further administrative proceedings,
PROVIDER and the AHCA agree as follows:
(1)
(2)
(3)
AHCA agrees to accept the payment set forth herein in settlement of the
overpayment issues arising from the MPI review.
Within thirty days of entry of the final order, PROVIDER agrees to make
a lump sum payment of one hundred sixty nine thousand eight hundred
thirty eight dollars and sixty eight cents ($169,838.68) plus one thousand
dollars ($1,000) in fines, for a total of one hundred seventy thousand eight
hundred thirty eight dollars and sixty eight cents ($170,838.68). This fully
and completely settles all claims in these proceedings before the Division
of Administrative Hearings (DOAH Case No. 06-0790). AHCA retains
the right to perform a 6 month follow-up review, to assure that
PROVIDER is in compliance with rules and law.
PROVIDER and AHCA agree that full payment, as set forth above,
resolves and settles this case completely. It will release both parties from
any liabilities arising from the findings in the audit referenced as C.I. 06-
3985-000.
Medical Diagnostic Laboratories, LLC
Settlement Agreement
(4) PROVIDER agrees that it will not rebill the Medicaid Program in any
manner for claims that were determined to be “not covered by Medicaid”
for the reasons which were the subject of the audit in this case.
6. Payment shall be made to:
AGENCY FOR HEALTHCARE ADMINISTRATION
Medicaid Accounts Receivable
Post Office Box 13749
Tallahassee, Florida 32317-3749
7. PROVIDER agrees that failure to pay any monies due and owing under the terms
of this Agreement shall constitute PROVIDER’S authorization for the Agency, without further
notice, to withhold the total remaining amount due under the terms of this agreement from any
monies due and owing to PROVIDER for any Medicaid claims.
8. AHCA reserves the right to enforce this Agreement under the laws of the State of
Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations.
9. This settlement does not constitute an admission of wrongdoing or error by either
party with respect to this case or any other matter.
10. Each party shall bear its own attorneys’ fees and costs, if any.
11. The signatories to this Agreement, acting in a representative capacity, represent
that they are duly authorized to enter into this Agreement on behalf of the respective parties.
12,‘ This Agreement shall be construed in accordance with the provisions of the laws
of Florida. Venue for any action arising from this Agreement shall be in Circuit Court, Leon
County, Florida.
13. This Agreement constitutes the entire agreement between PROVIDER and the
AHCA, including anyone acting for, associated with or employed by them, concerning all
matters and supersedes any prior discussions, agreements or understandings; there are no
Medical Diagnostic Laboratories, LLC
Settlement Agreement
promises, representations or agreements between PROVIDER and the AHCA other than as set
forth herein. No modification or waiver of any provision shall be valid unless a written
amendment to the Agreement is completed and properly executed by the parties.
14. _—‘ This is an Agreement of settlement and compromise, made in recognition that the
parties may have different or incorrect understandings, information and contentions, as to facts
and law, and with each party compromising and settling any potential correctness or
incorrectness of its understandings, information and contentions as to facts and law, so that no
misunderstanding or misinformation shall be a ground for rescission hereof.
15. With respect to the claims. that are the subject of this audit PROVIDER expressly
waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida
Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and
other proceedings to which it may be entitled by Jaw or rules of the Agency regarding this
proceeding and any and all issues raised herein. With respect to the claims that are the subject of
this audit PROVIDER further agrees that it shall not challenge or contest any Final Order entered
in this matter which is consistent.with the terms of this settlement agreement in any forum now
or in the future available to it, including the right to any administrative proceeding, circuit or
federal court action or any appeal.
16. This Agreement is and shall be deemed jointly drafted and written by all parties to
it and shall not be construed or interpreted against the party originating or preparing it.
17.‘ To the extent that any provision of this Agreement is prohibited by law for any
reason, such provision shall be effective to the extent not so prohibited, and such prohibition
shali not affect any other provision of this Agreement.
Medical Diagnostic Laboratories, LLC
Settlement Agreement
18. This Agreement shall inure to the benefit of and be binding on each party’s
successors, assigns, heirs, administrators, representatives and trustees.
19. _ All times stated herein are of the essence of this Agreement,
20. This Agreement shall be in full force and effect upon execution by the respective
parties in counterpart.
MEDICAL DIAGNOSTIC LABORATORIES, LLC
Dated: Q-|2-Olp , 2006
BY: ah Mordec At 5
(Print name)
irs: Chief Eyeeubve OLGol
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
fone 34 Dated: Bc2S , 2006
Jarfiés D. Boyd “
Inspector General
a Dated: za LY. , 2006
William Roberts
Dated: Yt AI __,2006
Acting General Counsel
L, Williath Porter II
Assistant General Counsel
PROVIDER ACKNOWLEDGEMENT STATEMENT
T_€h Mardecha, fl Ph. Ds , on behalf of Medical Diagnostic
(insert printed full name here)
Laboratories, LLC, a Medicaid provider operating under provider number 0307262-00,
do hereby acknowledge the obligation of Medical Diagnostic Laboratories, LLC, to
adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies.
Additionally, Medical Diagnostic Laboratories, LLC, acknowledges that Florida
Medicaid policy requires:
1) The Independent Laboratory Coverage and Limitations Handbook, (March 2003),
states under Duplicate Billing Not Allowed, that “Additional molecular diagnostic codes
83890-83912 may not be billed in conjunction with direct, amplified or quantification
procedure codes."
Date: O-44-0l
By:
SN
(signature)
Chie Cyerubve Ofc C
(title)
Return completed acknowledgement statement to Medicaid Program Integrity.
Corrective action plan -- Acknowledgement Statement
Final Agency Audit Report dated January 13, 2006
C.1. 06-3985-000
Corrective Action Plan — Acknowledgement Statement
A “corrective action plan” is the process or plan by which the provider will ensure
future compliance with state and federal Medicaid laws, rules, provisions, handbooks,
and policies. For purposes of this matter, the sanction of a corrective action plan shall
take the form of an “acknowledgement statement”, which is a written document
submitted to the Agency within 30 days of the date of the Agency action that brought rise
to this requirement. An acknowledgement statement: identifies the areas of alleged non-
compliance as determined by the Agency in this Final Audit Report (FAR);
acknowledges a requirement to adhere to the specific state and federal Medicaid laws,
rules, provisions, handbooks, and policies that are at issue in the FAR; and, must be
signed by the provider or its president, director, or owner.
The acknowledgement statement is due to Medicaid Program Integrity within 30
days of the issuance of this FAR. Please sign the enclosed statement and return it to:
Jill Smith
Agency for Health Care Administration
Medicaid Program Integrity
2727 Mahan Drive, Mail Stop # 6
Tallahassee, FL 32308-5403
Phone (850) 921-1802
Facsimile (850) 410-1972
Failure to comply with the requirements set forth above may result in the imposition
of additional sanctions, which may include monetary fines, suspension, or termination
from the Medicaid program.
Corrective action plan -- Acknowledgement Statement
Final Agency Audit Report dated January 13, 2006
CL. 06-3985-000
Docket for Case No: 06-000790MPI
Issue Date |
Proceedings |
Oct. 27, 2006 |
Final Order filed.
|
Sep. 08, 2006 |
Order Closing File. CASE CLOSED.
|
Sep. 08, 2006 |
Joint Motion to Relinquish Jurisdiction filed.
|
Jun. 27, 2006 |
Notice of Unavailability filed.
|
Jun. 14, 2006 |
Notice of Providing Answers to Respondent`s 1st Request for Admissions and 2nd Request for Production of Documents filed.
|
May 10, 2006 |
Order on Qualified Representative (J. Sherrin).
|
May 09, 2006 |
Order of Pre-hearing Instructions.
|
May 09, 2006 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for September 12 through 14, 2006; 9:30 a.m.; Tallahassee, FL).
|
May 02, 2006 |
Joint and Agreed Motion to Continue Hearing Date for at Least 120 Days, to September 2006 filed.
|
May 01, 2006 |
Letter to Judge Davis from J. Sherrin enclosing MDL`s request and affidavit for consideration filed.
|
Apr. 20, 2006 |
Answer to Respondent`s 1st Set of Interrogatories filed.
|
Apr. 13, 2006 |
Petitioner`s Third Request for Admissions filed.
|
Apr. 12, 2006 |
Petitioner`s Second Request for Admissions filed.
|
Apr. 12, 2006 |
Agency`s Response to Petitioner`s Request to Produce filed.
|
Apr. 10, 2006 |
Notice of Service of 3rd Set of Interrogatories filed.
|
Apr. 04, 2006 |
Petitioner`s Second Interrogatory to Respondent filed.
|
Mar. 30, 2006 |
Notice of Service of Interrogatories, Expert Interrogatories, Request for Admissions and Request for Production of Documents filed.
|
Mar. 24, 2006 |
Order of Pre-hearing Instructions.
|
Mar. 24, 2006 |
Notice of Hearing (hearing set for May 22 through 24, 2006; 9:30 a.m.; Tallahassee, FL).
|
Mar. 14, 2006 |
Joint Amended Response to Initial Order filed.
|
Mar. 13, 2006 |
Joint Response to Initial Order filed.
|
Mar. 06, 2006 |
Initial Order.
|
Mar. 06, 2006 |
Notice of Appearance (filed by J. Sherrin).
|
Mar. 03, 2006 |
Request for a Formal Hearing filed.
|
Mar. 03, 2006 |
Final Agency Audit Report filed.
|
Mar. 03, 2006 |
Notice (of Agency referral) filed.
|