STATE OF FLORIDA . ae AGENCY FOR HEALTH CARE ADMINISTRATION ; ‘ MEDI-FLO CARE, INC., Petitioner, vs. CASE NO. 06-2138MPEoXe. v7 JUDGE: Patricia M. Halt o, AGENCY FOR HEALTH CARE C.1. NO. 06-3990-000 = a ADMINISTRATION, oe » RENDITION NO.: AHCA-06-¢7.9.57 -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 a? tay of _ sv eyfFl_, 2006, in Tallahassee, Florida. Le OnE Krista Calamas, Secretary Agency for Health Care Administration 4 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: Jeffries H. Duvall, Esquire Agency for Health Care Administration (Interoffice Mail) Lawrence R. Metsch, Esq. Metsch & Metsch, P.A, Aventura Corporate Center 20801 Biscayne Blvd., Suite 307 Aventura, FL 33180-1423 (U.S. Mail) The Honorable Patricia M. Hart Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity, MS 6 Agency for Health Care Administration (Interoffice Mail) James Boyd, Inspector General, MS 4 Agency for Health Care Administration (Interoffice Mail) Finance and Accounting, MS 14 Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail and/or Interoffice Mail on this the 3” day of _ Hever _, 2006. Richard Shoop, Esquire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Tel: (850) 922-5873 Fax: (850) 921-0158 STATE OF FLORIDA “e AGENCY FOR HEALTH GARE ADMINISTRATION , “6 fogeh M4: MEDI-FLO CARE, INC., Hig OR oe 8 Petitioner, “AR, allie 3 vs Case No. 06-2138MPI Judge: Patricia M. Hart AGENCY FOR HEALTH CARE C.1. No. 06-3990-000 ADMINISTRATION, \ Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ("AHCA’ or “the Agency”), and Medi-Flo Care, Inc., ("PROVIDER"), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into for the purpose of Memorializing the final resolution of the matters set forth In this Agreement. 2. PROVIDER is a Medicaid provider (Medicaid provider no. 8849676-00) in the State of Florida, 3. In Its final agency audit report dated May 16, 20086, AHCA notified . PROVIDER that a 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 overpayment in the amount of $118,469.54. In response to the audit letter dated May 16, 2006, PROVIDER filed a petition for a formal administrative hearing. Subsequently and after additional information was provided, AHCA reviewed the disputed claims and determined the outstanding amount of overpayment should be adjusted to $10, 912.02 plus $500.00 in sanctions pursuant to cO"d ES:Tt sa@z@-ce-5nv Rule 59G.070(@) F.A.C. The provider was also sanctioned with the requirement of a Corrective Action Plan in the form of an acknowledgement statement. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: £8'd (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment Issues arising from the MPI review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make a single payment of eleven thousand four hundred twelve dollars and two cents ($11, 412.02) including $500.00 in sanctions in full and complete settlement of all monetary claims in this matter. Provider also agrees to sign a Corrective Action Plan. (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.1. No, 08-3990-000, (4) 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 6. PROVIDER agrees that failure to pay any monies due and owing under ES:TF 9aae-s2—9nY 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 Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations, 8. This settlament 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, except as set forth herein. 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. 41. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arlsing 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. Pa'd , £S:tT gsage-ce-ony 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. 414, 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. $@°d £S:TT 9aa2—-s2-9ny 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. 20. In the event either party breaches this Agreement, the costs and attorney fees incurred by the non-breaching party associated with enforcernent or collection activity pertaining to this Agreement shall be paid by the party breaching this Agreement to the non-breaching party. Medi-Flo, Care, Inc. Elo lb té ce4ms Dated: © p25) OL, 2008 Printed Representative’s Name BY: : > (signature) FLORIDA AGENCY FOR HEALTH GARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: > , 2006 Dated: , 2006 ZA Dated: _ threw. 2006 William H. Roberts Acting General Counsel - Q Cj ; we Dated: i , 2006 Kim Kellum Chief Medicaid Counsel 9a°d ES:TTt 9@a2-Gez-Hnv Corrective Action Plan — Acknowledgement Statement A “corrective action plan” is the process or plan by which the provider will ensure futute compliance with state and federal Medicaid laws, rules, provisions, handbooks, and policies, For purposes of this matter, the sanction of a corrective action plan shall take the form of an “acknowledgement statement”, which is a written document submitted to the Agency within 30 days of the date of the Agency action that brought rise to this requirement. An acknowledgement statement: identifies the areas of non- compliance as determined by the Agency in this Final Audit Report (FAR); acknowledges a requirement to adhere to the specific state and federal Medicaid laws, rules, provisions, handbooks, and policies that are at issue in the FAR; and, must be signed by the provider or its president, director, or owner. The acknowledgement statement is due to Medicaid Program Integrity within 30 days of the issuance of this FAR. Please sign the enclosed statement and retum it to: Jennifer Ellingsen Agency for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive, Mail Stop # 6 Tallahassee, FL 32308-5403 Phone (850) 921-1802 Facsimile (850) 410-1972 Failure to comply with the requirements set forth above may result in the imposition of additional sanctions, which may include monetary fines, suspension, or termination from the Medicaid program, Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated June 30, 2006 CI. 06-3990-000 48'd fS:TT 9@azZ-se-NnY 86°d WLOL PROVIDER ACKNOWLEDGEMENT STATEMENT 1 ELo lorddZins, on behalf of Medi-Flo Care, Inc., (insert printed full name here) a Medicaid provider operating under provider number 8849676-00, do hereby acknowledge the obligation of Medi-Flo Care, Inc, to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Medi-Flo Care, Inc, acknowledges that Medicaid policy requires: 1. The plan of care must be reviewed, signed and dated by the therapist and by the primary care provider, ARNP or PA designee, or designated physician specialist who prescribed the therapy. The physician’s signature indicates approval of the plan of care. The physician must review, certify, and re-sign the renewed plan of care every one to six calendar months depending on the approved authorization period. This must be done before the end of the authorization period. All signatures on the plan of care must be legible and dated. These requirements are currently found in the Florida Medicaid Therapy Services Coverage and Limitations Handbook, dated October 2003, By: GZ pate: Y [2S / 2 (signature) OWN EK [FRED WT (title) Return completed acknowledgement statement to Medicaid Program Jntegrity. Corrective action plan -- Acknowledgement Starement Final Agency Audit Report dated June 30, 2006 CL 06-3990.000

Docket for Case No: 06-002138MPI