STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ORLANDO REGIONAL HEALTHCARE SYSTEM, INC., Petitioner, DOAH CASE NO. 07-1512 AHCA NO. 2007003233 v. DETERMINATION NO. 20070216-011 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioner filed on March 20, 2007. On April 2, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On July 18, 2007, the Petitioner filed a Notice of Voluntary Dismissal with Prejudice, stating that it was voluntarily dismissing its Petition with prejudice. On July 20, 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 Petition is dismissed with prejudice and the Agency’s March 5, 2007, Determination is hereby upheld. Unless it has already done so, ACE American Insurance Company shall submit the correct reimbursement amount as stated in the Agency’s March 5, 2007, Determination to Orlando Regional Healthcare Systems, Inc. within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Arlene Cotton, R.N., AHCA WC Med Services, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, Florida 32399-4229. Petitioner shall govern itself accordingly. DONE and ORDERED this_/ day of Bout , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary AGENCY FOR HEALTH CARE ADMINISTRATI 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 : ts furnished by U.S. or interoffice mail to the persons named below on this 16 day of Apcel , 2008. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Honorable William F. Quattlebaum Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Donald R. Henderson, Esquire Mateer & Harbert, P.A. Post Office Box 2854 Orlando, Florida 32801 Janet Santos Orlando Regional Healthcare System, Inc. 1414 Kuhl Avenue Orlando, Florida 32806-2093 ACE American Insurance Company Two Liberty Place 1601 Chestnut Street Philadelphia, PA. 19103 Broadspire Services, Inc. Post Office Box 25102 Lehigh Valley, PA 18002-5102 Fairpay Solutions 14295 Midway Road, Suite 300 Addison, TX 75001 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance

Docket for Case No: 07-001512