FILED AHCA AGENCY CLERK STATE OF FLORIDA > 2001 JUN>~ 77 AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. CASE NO. 06-2122MPI PROVIDER NO. 021631300 MEDICAL DECISION, LLC, AUDIT NO. 05-2523-000 RENDITION NO.: AHCA-C7 O44 T -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 day of fine , 2007, in Tallahassee, Florida. Kr Ke c. ae oe M.D., 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) Lester J. Perling, P.A. Broad and Cassel 101 Northeast Third Avenue, Suite 1700 Fort Lauderdale, Florida 33301 (U.S. Mail) The Honorable Errol H. Powell Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity (Interoffice Mail) Linda Keen, Inspector General (Interoffice Mail) Finance and Accounting (Interoffice Mail) 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 A day of “ne, 2007. Richard Shoop, Agency rk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 (850) 922-5873 phone (850) 921-0158 fax STATE OF FLORIDA aa DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, ‘Petitioner, vO . Case No. 06-2122MPI MEDICAL DECISION, LLC, Respondent. / SETTLEMENT AGREEMENT ee eS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”) and MEDICAL DECISION, LLC. (“PROVIDER”), by and through the undersigned; inereby stipulate and aio as follows: - 1 The two: parties enter into this agreement for the purpose-of memorializing the resolution to this water. 2. PROVIDER is a Medicaid provider. in the State of Florida, provider number 021631300 and was a provider during the audit period. — , 3 In its Final Audit Report (final agency action) dated May 17, 2006, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPD, Office of the AHCA Inspector General, indicated that certain claims, in whole or in part, has been inappropriatély paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $22,906.52, a fine sanction of $1000.00 for violation(s) of Rule 59G-9.070(7)(e) F.A.C., and a Provider Acknowledgement Statement. In response to the audit Medical Decision, LLC Settlement Agreement letter dated May 17, 2006, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 06-2122. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) | AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (2) PROVIDER agrees to pay the Agency twenty three thousand nine hundred six and fifty-two cents ($23,906.52), which includes $1000.00 in sanctions, in one lump sum, and signed a Provider Acknowledgment Statement by June 15, 2007. AHCA retains the right to perform a 6 month follow-up review. (3) 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.I. 05-2523- 000. (4) PROVIDER agrees that it will not re-bill 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 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 Medical Decision, LLC Settlement Agreement 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 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 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, madein _.—- 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. Medical Decision, LLC Settlement Agreement 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 eee Medical Decision, LLC Settlement Agreement MEDICAL DECISION,LLC Dated: J/ 22 , 2007 ITS: Pres: Aeur AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 ; Dated: Lb “SF 2007 He ; : ; Inspector General General Counsel { hace LAC - Dated: Max o2/ 2007 Craig S * Dated: GH6 Sa , 2007 e sd] Medical Decision, L.L.C. PROVIDER ACKNOWLEDGEMENT STATEMENT 1 j Yan Tae -A 2 , on behalf of Medical Decision L.L.C., ~~ (insert printed full name here) _ ‘ a Medicaid provider operating under provider number 02 1631300, do hereby acknowledge the obligation of Medical Decision L.L.C . to adhere to state and federal Medicaid -laws, rules, provisions, handbooks, and policies. Additionally, Medical Decision L.L.C. acknowledges that Medicaid policy requires: (1) Medicaid reimburses for services that are determined to be medically necessary and do not duplicate another provider’s service. In addition to specific requirements applicable to DME equipment and supply procedure codes, procedure names, monthly maximum allowable reimbursement amounts, monthly maximum allowable units of service, limits, and other relevant payment information, services must meet the terms and conditions found in the provider enrollment agreement, the Florida Medicaid General Provider Handbook dated October 2003, and the current DME/Medical Supply Services Coverage and Limitations Handbook, Covered Services, Limitations, and Exclusions. Deccan LLC (2) As a result of this audit, Medical Gere-Semices will place particular emphasis on the following area: : : Medicaid may reimburse for a phototherapy light with photometer (E0202) if: * The attending physician diagnosis is neonatal jaundice; = The treatment is limited to five consecutive days and occurs during the first 30 days of life; and . » Treatment includes a fiberoptics system with the fiberoptics blanket, covers, light sources and related supplies. Date: f- 1-07 7 (title) a NSIT Return completed acknowledgement statement to Medicaid Program Integrity. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated May 17, 2006 C.1. 05-2523-000

Docket for Case No: 06-002122MPI