STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION FAIRPAY SOLUTIONS, BROADSPIRE SERVICES, INC. and CRUM SERVICES, Petitioners, DOAH CASE NO. 06-2114 AHCA NO. 2006004989 Vv. a : : a STATE OF FLORIDA, AGENCY FOR _ Ed 2 2 o4 HEALTH CARE ADMINISTRATION, m == <= =: acct SoS ry Respondent. i evs q ° | gas U / a m nN co ‘FINAL ORDER THIS CAUSE concerns a Petition for Formal Administrative Hearing (“Petition”) that the Petitioner filed on June 2, 2006. | On June 15, 2006, the Petition was forwarded to the Division of Administrative Hearings (“DOAH”) by the Agency and assigned to an Administrative Law Judge (“ALJ”). On August 10, 2006, the Respondent filed a Motion to Relinquish Jurisdiction to Agency for Health Care Administration for Entry of Final Order (“Motion”). In the Motion, the Respondent argued that there were no disputed issues of material fact, and that the case should be returned to the Agency for the issuance of a final order. On September 8, 2006, the ALJ assigned to the case issued a Recommended Order of Dismissal, relinquishing jurisdiction to the Agency and recommending that the Agency enter a final order dismissing the Petitioners’ Petition. In the Recommended Order of Dismissal, the ALJ found that Section 440.13(7)(b), Florida Statutes (2005), was a non-claim statute rather than a statute of limitation. As such, the Agency could have no jurisdiction to consider the Petitioners’ claim while the matter was before the Agency and neither could the Division of Administrative Hearings because the Petitioners failed to respond to the petition for dispute resolution within 10 days of receipt of the petition by certified mail as mandated by Section 440.13(7)(b), Florida Statutes (2005). The ALJ’s Recommended Order of Dismissal that was issued on September 8, 2006, is hereby incorporated and attached as part of this final order as Exhibit A. On September 26, 2006, the Petitioners filed exceptions to the Recommended Order of Dismissal. Tn their exceptions, the Petitioners argued that the carrier, Crum Services, was never properly served with a copy of the petition for dispute resolution. Because of this, the 10-day time limit under Section 440.13(7)(b), Florida Statutes (2005), for filing a response to the petition did not come into play. Thus, the ALJ should not have dismissed the case from DOAH. However, Petitioners’ argument is flawed. In essence, the Petitioners argued that the Agency’s interpretation of 440.13(7)(a), Florida Statutes (2005), and Rule 69L-7.602(5)(q), Florida Administrative Code, was erfoneous. Section 440.13(7)(2), Florida Statutes (2005) requires that a copy of a petition for reimbursement dispute resolution must be served “on the carrier and on all affected parties by certified mail.” Rule 69L-7.602(5)(p), Florida Administrative Code (2005), states that An insurer, service company/TPA or any entity acting on behalf of the insurer to pay, adjust and pay, disallow or deny a filed bill shall submit to the health care provider an Explanation of Bill Review, utilizing the EOBR codes and descriptions, as listed in paragraph (n) of this section, and shall include the insurer name and specific insurer contact information. (Emphasis added). The Explanation of Bill Review (EOBR) Florida Medical Center received from Petitioner, Broadspire Services, Inc., (which was attached to Petitioners’ Petition as Exhibit A) only identified the name and specific contact information for Broadspire Services, Inc. Thus, according to the EOBR, Broadspire Services, Inc. was either the carrier in this matter, or, in the alternative, was the designated entity for the purpose of receiving service of a copy of a petition for reimbursement dispute resolution by certified mail in this matter, pursuant to Section 440.13(7)(2), Florida Statutes (2005). It was undisputed that Florida Medical Center served Broadspire Services, Inc. with a copy of its petition for reimbursement dispute resolution by certified mail. The Agency, upon review of the petition and the EOBR, determined that . Broadspire Services; Iné. was either the carrier or the carrier's designee, and that the “carrier and all affected parties” had been properly served with a copy of ‘the petition by certified mail. “An . agency’s interpretation ofa statute or rule it has authority to administer should receive deference from a reviewing court and should not be overturned unless it is clearly erroneous.” See Proenza Sanfiel v. Department of Health, 749 So.2d 525, 527 (Fla. 5th DCA 1999), Petitioners made no showing that the Agency’s interpretation of Section 440, BOE), Florida Statutes (2005), and Rule 69L-7. 602(5\(p), Florida Administrative Code (2005), was clearly erroneous. It was also undisputed that the Petitioners failed | to respond to the petition for reimbursement dispute resolution within 10 days of being served with a copy of that petition. Because Petitioners failed to timely respond to the petition for reimbursement dispute resolution, they waived all objections to the petition for reimbursement dispute resolution. Therefore, as concluded by the ALJ in the Recommended Order of Dismissal, Petitioners are barred from seeking any of the relief requested in their Petition. IT IS THEREFORE ORDERED AND ADJUDGED THAT: Petitioners’ Petition is dismissed with prejudice. The Petitioner, Crum Services, shall reimburse Florida Medical Center an additional $4,350.40 ($5,319.56, which is 75% of the $7,092.74 billed by the Intervenor, - $969.16, which the Petitioner originally reimbursed the Intervenor) for services rendered to Patient S.B. on January 6, 2006. Petitioner, Crum Services, shall submit this additional reimbursement to Florida Medical Center within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Welby Cox-Myers, RN., Agency for Health Care Administration, 2727 Mahan Drive, MS #26, Tallahassee, Florida 32308.. Petitioners shall govern themselves accordingly. DONE and ORDERED this 7B day of A rrembe y/ , 2006, in Tallahassee, Florida. . Cc TA CALAMAS, Secretary AGENCY FOR HEALTH CARE ADMINISTRATION 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 1 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 f9 day of Mate bet”, 2006. COPIES FURNISHED TO: — Barbara J. Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tamela I. Perdue, Esquire Stiles, Taylor & Grace, P.A. Post Office Box 1140 Tallahassee, Florida 32301 Joanna Daniels Esquire Assistant General Counsel AHCA WC Med Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Jan Mills Facilities Intake Unit Elizabeth Dudek Health Quality Assurance RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873

Docket for Case No: 06-002114