STATE OF nips = E 18 AGENCY FOR HEALTH CA ENIS Fhe a ADH, 5 OF AMERISURE MUTUAL INSURANCE HEA Bal 7 VE COMPANY, s Petitioners, DOAH CASE NO. 07-1676 AHCA NO. 2007003871 Vv. DETERMINATION NO. 20061117-001 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION and JFK MEDICAL CENTER LIMITED PARTNERSHIP d/b/a JFK MEDICAL CENTER, - Respondents. os / FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioner filed on February 5, 2007. On April 12, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On May 30, 2007, the Petitioner filed a Notice of Voluntary Dismissal with Prejudice, dismissing its Petition. On June 4, 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 January 12, 2007 Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s January 12, 2007 Determination to JFK Medical Center within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Jeannette Fridich Iriye, R.N.. AHCA WC Med Services, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, Florida 32399-4229. The parties shall govern themselves accordingly. DONE and ORDERED this YA day of ( foul , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary AGENCY FOB) 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 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 {Ss day of Apel , 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 Daniel M. Kilbride Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Cindy R. Galen, Esquire Eraclides, Johns, Hall, Gelman, Eikner and Johannessen, LLP 2030 Bee Ridge Road Sarasota, Florida 34239 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Richard M. Ellis, Esquire Rutledge, Ecenia, Purnell & Hoffman, P.A. Post Office Box 551 Tallahassee, Florida 32302-0551 Jan Mills Facilities Intake Unit Elizabeth Dudek Health Quality Assurance

Docket for Case No: 07-001676