STATE OF FLORIDA —— . AGENCY FOR HEALTH CARE ADMINISTRATIONI -5 Ng @bgh STATE OF FLORIDA, AGENCY FOR é HEALTH CARE ADMINISTRATION, Petitioner, CASE NO. 06-1258MPI PROVIDER NO. 062794100 DAVID ROSENBERG, M.D., AUDIT C.I. NO. 01-1923-000 Rendition No. AHCA-06- -S-MDP vs. 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. a DONE and ORDERED on this the PT day of _ 378 , 2006, in Tallahassee, Florida. an Levine, Secretary 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: Karen Dexter, Esquire Agency for Health Care Administration (Interoffice Mail) Gary J. Clarke, Esquire Sternstein Rainer & Clarke, P.A. 411 E. College Avenue Tallahassee, Florida 32301 (U.S. Mail) D.M. McBride Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Vickie Divens, Medicaid Program Integrity Maryann Alliegood, Finance and Accounting CERTIFICATE OF SERVICE I 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 S day of “Jas __, 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 DIVISION OF ADMINISTRATIVE HEARINGS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. CASE NO. 06-1258MPI DAVID ROSENBERG, M.D., Respondent. / SETTLEMENT AGREEMENT. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and David Rosenberg, M.D. (“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 062794100 and was a provider during the audit period. . 3. In its Final Agency Audit Report (final agency action) dated April 6, 2005, 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, has been inappropriately paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $41,220.95. In response to the audit letter dated April 6, 2005, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 06-1258. David Rosenberg, M.D. Settlement Agreement 4. Jn order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) (2) (3) (4) 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 pay the Agency forty one thousand two hundred twenty dollars and ninety five cents ($41,220.95) plus 10% simple interest per year to be made in six (6) equal monthly installments in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 06-1258). AHICA retains the right to perform a 6 month follow- up review. Provider retains the right to pay in full without any interest penalty. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.J. 01-1923- 000. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 David Rosenberg, M.D. Settlement Agreement 6. 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. 7. AHICA 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees and costs, if any. 10. 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. 11. 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 Leon County, Florida. 12. 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 promises, representations or agreements between PROVIDER and the AHCA other than as set “Forth herein. No modification” or waivér of any provision-shall-be~valid-unless a written amendment to the Agreement is completed and properly executed by the parties. David Rosenberg, M.D. Settlement Agreement 13. 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. 14. 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 law or rules of the Agency regarding this proceeding and any and all issues raised herein. 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. 15. 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. 16. 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 shall not affect any other provision of this Agreement 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19, This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. David Rosenberg, M.D. Settlement Agreement DAVID ROSENBERG, M.D. Duh Astle mo Dated: 7 Boll py: Muo Avan ewe ml. (Print name) ITS: AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: 6 27 , 2006 , 2006 Jans D. Boyd Inspector General Chop Claws Dated: June dA-_, 2006 Christa Calamas General Counsel argh Dexter Assistant General Counsel Dated: bene. 7% , 2006 AGENCY FOR HEALTH CARE ADMINISTRATION AMORTIZATION SCHEDULE DAVID ROSENBERG, M. D./Provider 0627941-00 /C. |. # 01-1923-000 LOAN DATA Past Due Balance:|$41,220.95 Table starts at date: 06/15/2006 Annual int rate:} 10.00% or payment number: 1 Term in years:/0.5 Payments per year:|12 First payment due:|06/15/2006 CALCULATED PAYMENT Calculated payment:|$7,071.92 Monthly Pmt Used: [$7,071.92 $41,220.95 4st Pmt in Table: 4 Cumulative interest prior to payment 1: $0.00 Beginning Ending Cumulative | Payment Date Balance Balance Interest Amount Paid 1 | 06/15/2006 41,220.95 343.51 6,728.42 34,492.53 343.51 707102 | iz 2 | 07/15/2006 34,492.53 287.44 6,784.49 27,708.05 630.95 70192 [siz 3 | 08/15/2006 27,708.05 230.90 6,841.02 20,867.03 g61.85 | 707192 | i 4 | 09/15/2006 20,867.03 173.89 6,898.03 13,968.99 1,035.74 5 | 10/15/2006 13,968.99 116.41 6,955.52 7,013.48 1,152.15 7,071.92 6 | 11/15/2006 |_7.071.92 | 7,013.48 58.45 7,013.48 0,00 4,210.59 | 7,074.94 | jd Page 1 of 1 FIORDA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR ALAN LEVINE, SECR “4 CERTIFIED MAIL - RETURN RECEIPT No. 7001 0360 0003 3825 1326 April 6, 2005 Provider No: 062794100 David Rosenberg, MD. 3003 W. ML. Blvd. MAB 3" Floor Tampa, Florida 33607 Ol . | 45 & meL In Reply Refer to : FINAL AGENCY AUDIT REPORT CL No. 01-1923-000 Dear Provider: The Agency for Health Care Administration, Office of Medicaid Program Integrity has completed a review of claims for Medicaid reimbursement for dates of service during the period October 1, 2001, through March 31, 2002. A provisional agency audit report dated January 20, 2004 was sent to you indicating that we had determined you were overpaid $42,551.25. Based upon a review of all documentation submitted, we have determined that you were overpaid 41,220.95 for services that in whole or in part are not covered by Medicaid. Be advised that pursuant to Section 409,913(23)(a), Florida Statutes (F .S.), the Agency is entitled to recover all investigative, legal, and expert witness costs. Additionally, pursuant to Section 409.913, F.S., this letter shall serve as notice of the following sanction(s): The provider is subject to a : corrective action plan in the form of a provider acknowledgement statement addressing the findings of this case. Please see the attachment regarding the requirements for this sanction. This review and the determination of overpayment were made in accordance with the provisions of Section 409.913, F.8. In determining the appropriateness of Medicaid payment pursuant to Medicaid policy, the Médicaid program utilizes procedure codes, descriptions, policies, ‘ limitations and requirements found in the Medicaid provider handbooks and Section 409.913, F.S. In applying for Medickid reimbursement providers are required to follow the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, billing bulletins, ‘and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines. Below is a discussion of the particular guidelines related to the review of your claims, and an explanation of why these claims do not meet Medicaid requirements. The audit work papers are attached, listing the claims that are affected by this determination. Visit AHCA online at™ 2727 Mahan Drive « Mail Stop #6 www fdhe.siatajlus . Tallahassee, FL 32308 David Rosenberg M.D. Page 2 REVIEW DETIERMINATION(S) Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. The documentation you provided supports a lower level of office visit than the one for which you billed and received payment. The difference between the amount you were paid and the correct payment for the appropriate level of service is considered an overpayment. Medicaid policy addresses the requirement for enrollment and participation in the Medicaid program. You billed and received payment for services provided by an ARNP who was not a Medicaid provider. Payment made to you for services rendered by a non-Medicaid provider is considered an overpayment. : Medicaid policy specifies how medical. records must be maintained. A review of your medical records revealed that some services for which you billed and received payment were not documented. Medicaid requires documentation of the services and considers payments made for services not appropriately documented an overpayment. Medicaid policy states that, to receive the physician 100% reimbursement, Advanced Registered Nurse Practitioners and Physician assistants must be supervised by the treating physician. Supervision is shown by the physician’s dated signature on the medical record, You billed: Medicaid for services at the 100%.reimbursement level whetr the medical.record.did.not indicate that thé'service Was supervised. Twenty Péitent of the reimbursement is considered an overpayment. ” OVERPAYMENT CALCULATION Asandom sample of 30 recipients, with respect to whom you submitted claims to Medicaid, was reviewed, For the sample, an overpayment of $3,814.63 was found, as indicated on the accompanying schedule entitled: Overpayment Calculation Using Cluster Sampling, Since you ‘were paid for a total (population) of 2,895 claims for that period, the point estimate of the total overpayment is 2,895 x $22,17808134 = $64,205.55. Using a statistical formula, which is generally accepted for this purpose, we have calculated that the overpayment to you is 341,220.95 with a ninety-five percent (95%) probability that it is that amount or more. Ifyou are currently involved in a bankruptcy, you should notify your attorney immediately and provide a copy of this letter for them, Please advise your attorney that we need the following information immediately: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division); and, (4) the name, address, and telephone oumber of your attorney. If you are not in bankruptcy and you concur with our findings, remit by certified check in the amount of $41,220.95. The check must be payable to the Florida Agency for Health Care Administration. Questions regarding procedures for submitting payment should be directed to Medicaid Accounts Receivable, (850) 488-5869, To ensure proper credit, be certain your provider number and the audit number (C.I. 01-1923-000) are shown on your check, Please mail payment to: David Rosenberg MD. Page 3 Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 . Tallahassee, Florida 32317-3749 Tf payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409,913(27), F.S. Furthermore, pursuant to Sections 409.913(25) and 409.913(15), FS., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may result in termination from the Medicaid Prograni. You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. Ifa request for a formal hearing is made, the petition must be made in compliance with Section 28- 106.201, Florida Administrative Code (F.A.C.) and mediation may be available. If a request for an informal hearing is made, the petition must be made in compliance with rule Section 28- 106.301, F_A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this Jeter. For more information regarding your hearing and mediation rights, please see the attached Notice of Administrative Hearing and Mediation Rights. Questions should be directed to: Carolyn Milligan, Investigator, Agency for Health Care Administration, Medicaid Program Integrity, Office of Inspector General, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 921-1802, Sincerely, Ellen Williams AHCA Administrator EWi/td/ckm Enclosure(s) - 45/62/2885 11:53 8138761995 PEDIATRIC PULMONARY PAGE 18 (Page 4 of 3) David Rosenberg M.D. Page 4 . NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the right to request an administrative hearing pursuant to Sections 120.569 and 120,57, Florida Stanutes. If you disagree with the facts stated in the foregoing Final Agency Action Repart (hereinafter FAAR), you may request a formal administrative hearing pursvant to Section 120.37(1), Florida Stanites, If you do not dispute the facts stated in the FAAR, but believe there are additional reasons to grant the relief you seek, you may request an informal administrative hearing persuaat to Section 120,57(2), Florida Statutes. Additionally, pursuant to Section 120,573, Florida Staintes, mediation may be available if you have chosen a formal administrative hearing, as discussed more fully below. The written request for an administrative hearing must conform to the requirements of either Rule 28-106.201.(2) or Rule 28-106.301(2), Florida Administrative Code, and must be received by the Assistant Bureau Chief by 5:00 P.M. no later than 21 days ater you received the FAAR. The address for filing the written Tequest for an administrative hearing ts: . Assistant Burcan Chief . u request 5 iedliation, if it is available; vo .- is Support aii adjustment to the amauni owed ° ist ithe ‘parties “in ‘a“legal \aF you! aud the ‘Adenty ‘aired ig... Rather, you and the Agen B.¢ Ra ' the, . 2,

Docket for Case No: 06-001258MPI