ys STATE OF FLORIDA . i he a AGENCY FOR HEALTH CARE ADMINISTRATION & or 208 JUN 17 A Ik 0 2, nae fs! f2a, 1: 55 TECHNOLOGY INSURANCE ADM oN Ay - COMPANY, INC., HEARINGS |” Petitioner, DOAH CASE NO. 07-0484 AHCA NO. 2007000945 v. DETERMINATION NO. 20061127-006 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, / FINAL ORDER THIS CAUSE concerns an Amended Petition for Formal Administrative Hearing (“Petition”) that the Petitioner filed on January 24, 2007. On January 26, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On March 13, 2007, the Petitioner filed a Notice of Dismissal of Petition for Administrative Hearing, stating that the parties had resolved the dispute. _On March 14, 2007, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioner’s Amended Petition is dismissed with prejudice and the Agency’s January 2, 2007, Amended Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s January 2, 2007, Amended Determination to Parkway Regional Medical Center within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Ms. Twan J; ackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this _/% day of ftere , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary AGENCY FOR EEALTH CARE ADMINISTRATIO 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 I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been a furnished by U.S. or interoffice mail to the persons named below on this /6 day of June , 2008. COPIES FURNISHED TO: RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 Don W. Davis Administrative Law Judge Division of Administrative Hearings Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation The DeSoto Building 200 East Gaines Street 1230 Apalachee Parkway Tallahassee, Florida 32399-4229 Tallahassee, Florida 32399-3060 Tamela I. Perdue, Esquire Jan Mills Stiles, Taylor & Grace, P.A. Facilities Intake Post Office Box 1140 Tallahassee, Florida 32302 Parkway Regional Medical Center Elizabeth Dudek .| P.O. Box 740941 Health Quality Assurance Atlanta, Georgia 30374 Tenet Regional Business Office 4660 Communication Avenue Boca Raton, Florida 33431

Docket for Case No: 07-000484