STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS FLORIDA HEALTHCARE CORP., Petitioner, vs CASE NO. 06-1527MPI CI NO. 04-2066-000 AGENCY FOR HEALTH CARE . -OTOIR4 -S-MDO ADMINISTRATION, RENDITION NO.: AHCA-'7-O12-4 Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed a “Stipulation and Agreement,” which is incorporated by reference. The parties are directed to comply with the terms of the “Stipulation and Agreement.” Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the G7 day of kb. , 2007, in Tallahassee, Leon County, Florida. pre Ze C. Agwunobi, a) Secretary Agency for Health Care Administration CASE NO. 06-1527MPI C.I. NO. 04-2066-000 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: Anthony C. Vitale, Esquire Christopher A. Parella, J.D, CHC Health Law Offices 799 Brickell Plaza, Suite 700 Miami, Florida 33131 Debora Fridie, Esquire Attorney for Agency Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 The Honorable Stuart M. Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Medicaid Program Integrity, MS #6 CASE NO. 06-1527MPI C.I. NO. 04-2066-000 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished to the above named addressees by U.S. Mail on this the Zg* day of A re 5 , 2007. Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 é >, Mp ty ~ x “sy ani, * 7a STATE OF FLORIDA Le Mo wy DIVISION OF ADMINISTRATIVE HEARINGS bhliges, oy . “Ap fieg Gs ? FLORIDA HEALTHCARE CORP., "OS by Se Petitioner, vs. Case No. 06-1527MPI Provider No. 390106801 C.r. No. 04-2066-000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / STIPULATION AND AGREEMENT The Petitioner, FLORIDA HEALTHCARE CORP., (a/k/a and hereinafter “PROVIDER”), and the Respondent, AGENCY FOR HEALTH CARE ADMINISTRATION (a/k/a and hereinafter “AHCA” OR “Agency”), 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, operating under provider number 390106801. 3. In its Final Audit Report, C.I. No 04-2066-000, (the "Audit Letter" or “FAR”) dated March 31, 2006, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought repayment of an overpayment in the amount of as] b ie] oD feo a fan Case No. 06-1527MPI C.I. No. 04-2066-000 Florida Healthcare Corp. vs. AHCA Stipulation and Agreement $74,272.08. AHCA also notified PROVIDER in the FAR that it is seeking sanctions in the form of a $3,000.00 fine and a corrective action plan in the form of a provider acknowledgement statement. The sanctions were imposed pursuant to Rule 59G- 9.070, Florida Administrative Code. In response, PROVIDER petitioned for a formal administrative hearing. After the provider requested a formal administrative hearing, AHCA reviewed documentation that was previously unavailable to them. Based upon that review, AHCA adjusted the overpayment to $68,596.42, PROVIDER has agreed to pay the overpayment amount of $68,596.42, some of AHCA’s investigative costs in the amount of $2,000.00, and a sanction in the amount of $3,000.00 for a total repayment amount of $73,596.42. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA will accept the payment set forth herein as a complete resolution of the overpayment issues arising from the MPI review cited in paragraph 3 above. (b) PROVIDER agrees to pay the adjusted overpayment amount of Sixty-Eight Thousand Five Hundred Ninety-Six and 42/100 Dollars ($68,596.42), Two Thousand Dollars ($2,000.00) in costs to AHCA, and a sanction in the Page 2 of 11 se No. 06-1527MPI «I. No. 04-2066-000 orida Healthcare Corp. vs. AHCA tipulation and Agreement amount of Three Thousand and 00/100 Dollars ($3,000.00) for a total amount of Seventy-Three Thousand Five Hundred Ninety-Six and 42/100 Dollars ($73,596.42). The adjusted overpayment amount plus costs, in the total amount of $73,596.42 shall be paid in six (6) installment payments, which amounts include principal and statutory interest, as follows: Twelve Thousand Six Hundred Twenty~-Six and 30/100 dollars ($12,626.30) for the first five (5) installment payments and Twelve Thousand Six Hundred Twenty~Six and 33/100 dollars ($12,626.33) for the sixth (6%) installment payment. By no later than thirty (30) days from the date of the Final Order, PROVIDER agrees to make the first installment payment to AHCA of Twelve Thousand Six Hundred Twenty-Six and 30/100 Dollars ($12,626.30). PROVIDER shall pay each subsequent installment payment on the balance due within thirty (30) days of the due date of the previous payment until the overpayment amount is paid in full. In the event that the PROVIDER pays the balance due early, there is no penalty for early payment. The outstanding balance of $73,596.42 will accrue interest at the rate as set forth in Section 409.913(25) (c), Page 3 of 11 Case No. C.1. No. 06-1527MPIL 04-2066-000 Florida Healthcare Corp. vs. AHCA Stipulation and Agreement Florida Statutes, (2004), until the balance is paid in full. AHCA retains the right to perform a 6-month follow-up review. PROVIDER is responsible for ensuring timely delivery of the payment. Failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to accrue until the entire balance is paid. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as C.I. Number 04-2066-000. 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. PROVIDER agrees to fully cooperate with any follow up reviews conducted by the Agency. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Page 4 of Il No. O6-1527MPI No. 04-2066-000 a Healthcare Corp. vs. AHCA ation and Agreement And payment shall clearly indicate that it is per a stipulation and agreement and shall reference the C.I. Number and the Provider Number. 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. AHCA reserves the right to enforce this Stipulation and Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 8. Except as specifically set forth in paragraphs 3 and 4(b) above with regard to AHCA’s investigative costs and the sanction to PROVIDER, the parties agree to bear their own attorney’s fees and cther costs, if any. 9. As a part of this Stipulation and Agreement, PROVIDER agrees that AHCA may impose an administrative sanction pursuant to rule 59G-9.070, Florida Administrative Code, as referenced in paragraph 3 above. Page 5 of 11 ase No. 06-i527MPI - No. 04-2066-000 orida Healthcare Corp. vs. AHCA : 1 tipulation and Agreement yaa Ho” w 10. PROVIDER acknowledges that Medicaid policy states: (a). Medicaid Policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. (ob) Medicaid policy specifies how medical records must be maintained. Medicaid requires documentation of the services and considers payments made for services not appropriately documented an overpayment. {c) Medicaid policy states that “to be reimbursed the maximum fee for a radiology service, the physician must provide both the technical and professional components.” (d) Medicaid policy states that “manual or automated dipstick urine tests performed as a part of a visit are not reimbursed in. addition to the visit.” (e) Medicaid policy requires that services performed be medically necessary for the diagnosis and treatment of an illness and must meet the Medicaid criteria for medical necessity. (f) Medicaid policy requires the use of appropriate codes when rendering services that are psychiatric in nature and not billing using Office Consultations and Evaluation and Management Services procedure codes. Page 6 of il se No. 06-1527MPI -T, No. 04-2066-000 iorida Healthcare Corp. ys. AHCA tipulation and Agreement (g) Medicaid policy states that “In order to qualify as a basis for reimbursement, the record must be signed and dated at the time of the service, or otherwise attested to as appropriate to the media. Rubber stamp signatures must be initialed.” 11. The signatories to this Agreement, acting ina representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Stipulation and Agreement to AHCA; however a facsimile copy shall be sufficient to enable AHCA to cancel a hearing scheduled in this case. 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 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 promises, representations or agreements between PROVIDER and the AHCA other than as set forth herein. No Page 7 of 11 ase No. 06-1527MPI I. No. 04-2066-000 lorida Healthcare Corp. vs. AHCA tipulation and Agreement c Cc. 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. This Stipulation and Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be resolved because the parties have agreed to the terms contained within this agreement. 15. 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 entitied by law or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that the Agency should issue a Final Order which Page 8 of il Case No. 06-1527MPI C.I. No. 04-2066-000 Florida Healthcare Corp. vs. AHCA Stipulation and Agreement is consistent with the terms of this Stipulation and Agreement, and which adopts this agreement and closes this matter. 16. PROVIDER does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter, C.I. No. 64-2066-000, and AHCA’s actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Provider. 17. This Stipulation and 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. 18. To the extent that any provision of this Stipulation and 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 Stipulation and Agreement. Page 9 of 11 Case No. 06-1527MPI C.I. No. 04-2066-000 Florida Healthcare Corp. vs..AHCA Stipulation and Agreement AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 By: Fondo h Noten Linda Keen Inspector General Date: 4 “LY , 200 7 BY: Craig H. Smith General Counsel Date: 2/14 , 200.7 . x az BY: } Tac Qh? DEBORA E. FRIDIE Assistant General Counsel Date: Fb ev ory G , 200 /

Docket for Case No: 06-001527MPI