STATE OF FLORIDA __ DIVISION OF ADMINISTRATIVE HEARINGS SOUTH POINT PHARMACY CORPORATION, Petitioner, CASE NO: 06-1545MPI v. C.I. No. 06-4164-000 JUDGE: CLAUDE ARRINGTON STATE OF FLORIDA, AGENCY F ‘OR Medicaid Provider No.: 026775900 HEALTH CARE ADMINISTRATION, Respondent, / ; FINAL ORDER The parties resolved all disputed issues and executed a Settlement Agreement, which is incorporated by reference, 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 Levy Of PEW? |, 2006, in Tallahassee, Florida, of? oe Chrfsta Calamas, Secretary Agency for Health Care Administration 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: Nelson Suarez South Point Pharmacy Corporation 1835 West Flagler Street, Suite 204 Miami, Florida 33135 John G. Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399 Anthony L. Conticello, Esquire Agency for Health Care Administration (Interoffice Mail) James D. Boyd, Inspector General Agency for Health Care Administration (Interoffice Mail) Timothy Byrnes, Bureau Chief Medicaid Program Integrity Agency for Health Care Administration (Interoffice Mail) Bureau of Finance and Accounting Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE — LE 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 /Z* tayo ae hoop, Agency Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA iy v4 EO DIVISION OF ADMINISTRATIVE HEARINGS Lp AD. 2 SOUTH POINT PHARMACY Wien 4y, POKES “O, «a Sapa Petitioner, ae; ye : vs. CASE NO. 06-1545MPI JUDGE: Claude B. Arrington STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and South Point Pharmacy, (“Provider”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into between the parties for the purpose of avoiding the costs and burdens of litigation, and neither party concedes the other’s position. 2. Provider has the following Florida Medicaid Provider 0267759 00. 3. Inits Final Agency Audit Report C.I. No. 06-4164-000 dated March 28, 2006 (hereafter, “Audit Report”), AHCA notified Provider that review of Medicaid claims performed by Medicaid Program Integrity (MPI) for the period December 1, 2004, to November 30, 2005 (the “Audit Period”), indicated that, in its opinion, some Medicaid claims in whole or in part were not covered by Medicaid. The Agency initially sought overpayment in the amount of $4,383.66, In response, Provider filed a petition for a formal administrative hearing and the matter was sent to the Division of Administrative Hearings for a formal hearing and was assigned Case No: 06- 1545MPI. . The matter was remanded to the Agency by the Division of Administrative Hearings for the purposes of allowing the parties time to resolve the overpayment issues. The Agency reviewed the additional documentation and considered arguments of Petitioner, which resulted in an adjusted overpayment amount of $1,275.06 (the “Adjusted Overpayment”), Petitioner agrees to pay the entire Adjusted Overpayment plus an additional $1,000.00 in costs for a total settlement amount of $2,275.06 (the “Total Settlement Amount”). Provider also agrees as to complete the Provider Acknowledgement Statement attached to the FAAR and file it with AHCA within thirty (30) days of the date of the final order. A true and correct copy of the Provider Acknowledgement Statement is attached and incorporated into this Settlement Agreement. - In order to resolve this matter without resort to further administrative proceedings, Provider and AHCA expressly agree as follows: (A). AHCA shall accept full payment set forth herein in settlement of all overpayment issues arising from the MPI review, including AHCA’s investigative costs. (B) Within thirty (30) days of receipt of a Final Order incorporating this Settlement Agreement, Provider agrees to pay to AHCA the Total Settlement Amount as set forth in paragraph no. 4 ($2,275.06). tu (C) Provider and AHCA agree that full payment as set forth above will resolve and settle this case completely and telease both parties from all liabilities arising from the Audit Report. (D) 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 Report. | (E) This Settlement Agreement does not constitute an admission of guilt, wrongdoing or error by either party with respect to this case or any other matter. (F) Provider agrees to execute the Provider Acknowledgement Statement and file it with AHCA within 30 days of the date of the Final Order, 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall reference both the Provider Number, and the C.I. Number. 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. The parties agree to bear their own attorney’s 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. 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 Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel a final hearing, if one is pending, and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. 11. This Agreement shail 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 waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 13. This is an Agreement of settlement and compromise, made in Ttecognition that the parties may have different or incorrect understandings, information and contentions, as to facts and Jaw, 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 tight 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 tules 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 is consistent with the terms of this settlement, that adopts this agreement and closes this matter. 15. 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.L. No. 06-4164-000, AHCA?’s actions herein, including, but not limited to, any claims that were or may be asserted i in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Facility. 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 Teason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this 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. PETITIONER: SOUTH POINT PHARMACY Dated: A-'S- 2006 , 2006. By: Y1.S Nelson Suarez irs: Sw fo President AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 _Zretisl Dated: By S D. BOYD Inspector General Ak OZ OY ae Dated: WILLIAM H. ROBERTS Acting Gene: ‘ounsel L. CONTICELLO Assistant General Counsel fee Wet , 2006. _, 2006. Dated: 2006. lO/ 26 South Point Pharmacy Corporation PROVIDER ACKNOWLEDGEMENT STATEMENT X—— EE EEE BI GEMENT STATEMENT I NELSON suaRnes_ , on behalf of South Point Pharmacy (insert printed full name here) Corporation, a Medicaid provider operating under provider number 026775 900, do hereby acknowledge the obligation of South Point Pharmacy Corporation to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. : Additionally, South Point Pharmacy Corporation acknowledges that Medicaid policy requires: (1) A Medicaid provider must retain medical, professional, financial, and business records pertaining to goods and services furnished to Medicaid recipients for a period of at least five (5) years from the dates of service, in accordance with Section 409.913 (9), Florida Statutes (F.S.), the Medicaid Provider Agreement, and the July 2001 Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook page 2-17, (2) A Medicaid provider must demonstrate the availability of sufficient quantities of goods during a specific audit or review period to support the provider's billings to the Medicaid program, in accordance with Section 409.913 (15)(n), F.S. and the July 2001 Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook, page 2-18. . By: V1 S AN Date: 9-5- OG (signature) POES st (title) Return completed acknowledgement statement to Medicaid Program Integrity. Corrective Action Plan — Acknowledgement Statement Final Agency Audit Report dated March 28, 2006 C.I. 06-4164-000/P/AAE “pare T= S~ OE” Steam 1 $ 2 2765, 06 a ie AAS So. ee er AQ DOLLARS “| fl PAY TO THE OADER oF. fs. VU. s CEN a -—— SS 8001: Ponca:De Leo, —— i SS ' = Coral Gables, Fi GUARDIAN @ sarEry 3 | a | EG { 8) Bi 3

Docket for Case No: 06-001545MPI