Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: MARE, INC., D/B/A MARE PHARMACY DISCOUNT
Judges: LINDA M. RIGOT
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Apr. 12, 2007
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, July 11, 2007.
Latest Update: Dec. 23, 2024
FILED
STATE OF FLORIDA _, AHCA
AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY CLERK
1081 OCT ~4 > x gp
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner, DOAH CASE NO. 07-1977MP1
C.L. No. 07-5280-000
\ JUDGE: LINDA M. RIGOT
RENDITION NO.: AHCA-07- QLeOG5- Dee
MARE, INC., d/b/a MARE PHARMACY .
DISCOUNT,
VS.
Respondent.
/
RE
FINAL ORDER
Bo: v S- LOE
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 _/ day of (et , 2007, in
Tallahassee, Florida.
poe 1k Cc. dad, Secretary
Vim 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)
Lawrence R. Metsch, Esq.
The Metsch Law Firm, P.A.
20801 Biscayne Blvd., Suite 307
Aventura, FL 33180-1423
(U.S. Mail)
- The Honorable Linda M. Rigot
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(U.S. Mail)
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 tiny of _Cetpber, 2007.
ae
Richard Shoop, Agency Clerk
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
DIVISION OF ADMINISTRATIVE HEARINGS
‘ 0
AGENCY FOR HEALTH Cage WL 14 200?
ADMINISTRATION,
Petitioner,
vs, we CASE NO. 07-1677MP1
MARE, INC. d/b/a
MARE PHARMACY DISCOUNT
Respondent.
ee |
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and Mare, Inc. d/b/a Mare Discount Pharmacy (“PROVIDER”), by
and through the undersigned, hereby stipulate and agree as follows:
1, The two parties enter into this agreement for the purpose of memorializing the
resolution to this matter.
2. PROVIDER is a Medicaid provider in the State of Florida, provider number
022474000 and was a provider during the audit period,
3. In its Final Audit Report (final agency action) dated March 2, 2007, AHCA
notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity
(MPI), Office of the AHCA Inspector General, indicated that certain claims, in whole or in pan,
has been inappropriately paid by Medicaid. The Agency sought recoupment. of. this
overpayment, in the amount of $195,515.89, a fine sanction of $5,000.00 for violation(s) of Rule
59G-9.070(7)(n) F.A.C.. In Tesponse to the audit letter dated March 2, 2007, PROVIDER filed
a petition for a formal administrative hearing, which was assigned DOAH Case No, 07-
1677MPI.
AAS?T AARE-GE-TWIL
* Mare, Inc. d/b/a Mare Discount Pharmacy
Settlement Agreement
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 two hundred thousand five hundred
eighteen dollars and eighty nine cents ($200,515.89), which includes
$5,000.00 in sanctions, in twelve (12) equal monthly payments including
“10% statutory simple interest, with the first payment due on or before
September 1, 2007 and on the 1" of each month thereafter in full and
complete settlement of all claims. 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.1, 07-5280-
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,
3. 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
Aree antoarser
". Mara, Inc, d/b/a Mare Discount Pharmacy
Settlement Agreement
notice, to withhold the total remaining amount due under the tenns 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 attomeys’ 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 Tespective parties,
ll. 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, conceming 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, 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 ‘potenitial
correctness or incorrectness of its understandings, information and contentions as to facts and
Jaw, so that no misunderstanding or misinformation shall be a ground for rescission hereof,
Brest JARS ATI
my Mare, Inc. d/b/a Mare Discount! Pharmacy Ww
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 jt may be entitled by Jaw or
Tules 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
Teason, 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.
At:FT JARe-Ae Te
Besrzang
Mara, Inc. d/n/a Mare Discount Pharmacy
Satlement Agraament
MARE, + Viva MaRp DISCouNT PHARMACY
AGENCY FoR REALTE CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL, 32308-5403
Deed: oo FX , 2007
Dexter.
Assistant General Counse]
TET LGRE-BE-WE .
ead ween a
PHL
(Page 1 af 7)
FIDGA AGERICY FOR HEALTH CART ATAUNSTRATION
CHARLIE CRIST . ANDREW C. AGWUNOBI, M.D.
GOVERNOR BEGRETARY
CERTIFIED MAIL No. 7004 2510 0001 4447 0593
March 2, 2007
Provider No.: 0224740 00
License No,; PH0009053
Ana Nelida Cabrera, President
Mare, Ine,
d/b/a Mare Pharmacy Discount
5350 Palm Avenue
tHinleah, FL 33012
In Reply Refer to o
FINAL AUDIT REPORT
C,], No, 07-5280-000/P/KNE
Dear Mz, Cabrera;
The Agency for Health Care Administration (the Agency), Bureau of Medicaid Program
Integrity, has completed a review of claims for Medicaid reimbursement for dates of service
during the period January 1, 2005, through December 31, 2005. A preliminary audit report
dated Junuary 31, 2007 was sent to you indicating that we had determined you were overpaid
$195,515.89, Based upon a review of all documentation submitted, we have determined (hat you
were overpaid $195,515.89 for services that in whole or in part are not covered by Medicaid, A
fine of 55,000 has been applied, The total amount due is $200,515.89, '
Be advised of the following:
(1) Pursuant to Section 409.913(23)(a), Florida Statutes (F.S,), the Agency is entitled to
recover all investigative, legal, and expert witness costs,
(2) In accordance with Sections 409.913(15), (16), and (17), F.S., and Rule 59G-9,070,
Florida Administrative Code (F.A.C,), the Agency shall apply sanctions for violations
of federal and state laws, including Medicaid policy, This letter shall serve as notice
of the following sanction(s):
eA fine of $5,000 for violation(s) of Rule Section 590-9.070(7)(n), F.A.C.
FLORIDA Visil AHCA online of
1G facusttetunie hiip:/iahea, myflorida,com
Rie Www.FlarldaGompareCare.gov
“Reina SmpareCare,g!
2727 Mohan Orlve, M5e B
Tallahasseo, Flosida 32908
(Page 2 of 7)
Mare, Inc,
d/b/a Mare Pharmacy Discount
Case 07-5280-000/P/KNH
Page 2 . .
This review and the determination of overpayment were made in accordance with the provisions
of Section 409.913, F.S. In determining the appropriateness of Medicaid payment pursuant to
Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies,
limitations and requirements found in the Medicaid provider handbooks and Section 409,913,
F.5, In applying for Medicaid reimbursement, providers are required to follow the guidelines set
forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy
handbooks, billing bulletins, and the Medicaid provider agreement, Medicaid cannot pay for
services that do not meet these guidelines, :
Below is a. discussion of the particular guidelines related to the review of your claims, and an
explanation of why these clalms do not meet Medicald requirements, The audit work papers arc
attached, listing (he claims that are affected by this determination,
REVIEW DETERMINATION(S)
The audit included two reviews, 4 prescription medical records review and a purchasc acquisition
records review, The outcome of both reviews determined the final overpayment due as well as
the sanctions imposed,
‘The audit included the review of a judgmental sample of svlected claims taken from the
population of paid claims with dates of service during the audit period, The audit period for this
review was from January 1, 2005, through December 31, 2005. This review identified an
overpayment of $396.49. Enclosed for this review are the overpayment calculations, a summary
of documented discrepancies, and an itemized listing of discrepancies noted In the review of the
judgmental sample. :
‘The audit included a comparison of your lawful documented product sequisitions with your paid
Medivnid claims, Only product acquisitions fram Florida licensed wholesalers were included in
the audit, The-audit period for this review was from January 1, 2005, through December 31,
2005, The drug quantity paid for by Medicaid for the drugs reviewed exceeded the quantity
available Lo dispense to Medicaid recipients. This review Identified an overpayment of
$195,515.89, Enclosed for this review are the overpayment calculations which include the
summary sheel(s), pald claims duta, and acquisition data,
If you are currently invalved {na bankruptcy, you should notify your attorney immediately and
provide a copy of this letter for them, Please advise your atlomey thal we need the following
informution immediniely: (1) the date of ling of the bankruptcy petition; (2) the case number;
(3) the court name and the division in which the petition was filed (e.g, Northern District of
Florida, Tallahassee Division); and, (4) the name, address, and telephone number of your
atlomey, .
{Page 3 of 7)
Mare, Inc,
d/b/a More Pharmacy Discount
Case 07-5280-000/P/KNH
Page 3 . om
If you are not in bankruptey and you concur with our findings, remit by certified check in the
umount of $200,515.89, which includes the overpayment smount as well as any fines imposed,
The check must be payable to the Florida Agency for Health Care Administration, Questions
regarding proceduras for submitting payment should be directed to Medicaid Accounts
Reecivable, (850) 488-5869. To ensure proper vredil, be certain you legibly record on your
check your Medleald provider.number and the C.J, number listed on the first page of this audit
‘report, Please mail payment to:
Agency for Health Care Administration
Medicaid Accounts Receivable
P.O, Box 13749
Tallahassee, Florida 32317-3749
If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency
may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(27),
F.S, Furthermore, pursuant to Sections 409,913(25) and 409,913(15), F.S., failure to pay in full,
or enter into and abide by the terms of any repayment schedule set forth by the Agency may
result in termination from the Medicaid Program, Likewise, failure lo comply with ull sunctions
applied or due dates may result in-additional sanctions being imposed,
You have the right to request a formal or informal hearing pursuant to Section 120.569, FS. Ifa
request for a formal hearing is made, the petition must be made in compliance with Section 28-
106,201, F.A.C. and mediation may be avullable. Ifa request for an Informal hearing is made,
the petition must be made in compliance with rule Section 28-106,301, F.A,C. Additionally, you
arc hereby informed that if a request for a hearing is made, the petition must be reccived by the
Agency within twenty-one (21) days of receipt of this letter, For morc information regarding
your henring and mediation rights, please sce the attached Notice of Administrative
Hearing and Mediution Rights. :
Any questions you may have ubout this matter should be directed lo; Kathryn N, Holland,
Senior Pharmacist, Agency for Heulih Care Administration, Medicaid Program Integrity,
2727 Muhun Drive, Mail Stop #6, Tallahassee, Floride 32308-5403, telephone (850) 921-
1802, facsimile (850).410-1972. :
Sincerely,
BD hog
D, Kenneth Yon
AHCA Administrator
Enclosure(s)
eo; Benjamin R, Metsch
The Metsch Law Firm, PA,
(Pane 4 of 7)
More, Inc, Co
d/b/a Mare Pharniacy Discaunt
Case 07-5280-000/P/KNH
Page 4
ee ee ee
NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS
You have the right to request an administrative hearing pursuant to Sections 120,569 and
120.57, Florida Statutes, If you disagree with the facts stated in the foregoing Final Audit Report
(hereinafter FAR), you may request a formal administrative hearing pursuant to Section 120.57(1)
Florida Statutes, [f you do nat dispute the facts stated in the FAR, but believe there are additional
reusons to grant the relief you seek, you may request an informal administrative hearing pursuant
1o Section 120.57(2), Florida Statutes, Additionally, pursuant to Section 120,573, Florida Statutes,
mediation may be available if you have chosen a formal administrative hearing, as discussed more
fully below, ;
. : ‘The written request for an administrative hearing must conform to the requirements of
either Rule 28-106,201(2) or Rule 28-106,301(2), Florida Administrative Code, and must be
received by the Assistant Bureau Chief by 5:00 P.M, no later than 21 days after you received the
FAR, The address for filing the written request lor an administrative hearing is:
Assistant Bureau Chief 7
Medicaid Program Integrity
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #6
Tallahassee, Florida 32308
The request must be legible, on 8 ¥% by 11-Inch white paper, and contain;
1. Your name, address, telephone number, any Agency identifying number on the FAR, if
known, and name, address, and talephone number of your representative, if any; .
2, An \expianation of how your substantial interests will’be affected by the action described
in the FAR;
3. A sintement of when and how you received the FAR;
4. Fora request for formal hearing, a statement of all disputed issues of material fuct,
5, For arequest for formal hearing, a concise statement of the ultimate facts alleged, as well
as the rules and statutes which entitle you to relief;
6. For a request for formal hearing, whe
7, Fora request for informal hearin
to the Avency; and
8. A demand for relicf,
er you request mediation, if it is available;
g, What bases support an adjustment to the amount owed
A formal hearing will be held if there are disputed issues of material fact, Additionally,
mediation may be available in conjunction with a formal hearing, Mediation is a way to use a
neutral third party to assist the parties In a legal or. administrative proceeding to reach a
settlement of their case. If you and the Agency agree to mediation, it does not mean that you
aive. up the right to.a hearing, Rather, you and the Agency will try to scttle your case first with
mediation.
If you request mediation, and the Agency agrees to if, you will be contacted by the
Agency to set up a time for the mediation and to enter into a mediation ngreement, If a
mediation agreement is not reached within 10 days following the request for mediation, the
matter will proceed without mediation, The mediation must be concluded within 60 days of
having entered into the ngreement, unless you and the Agency agrec to a different time period,
The mediation agreement between you and the Agency will include provisions for sclecting the
mediator, the allocation of costs and fees assoclated with the mediation, and the confidentiality
of discussions and documents involved in the mediation. Mediators charge hourly fees that must
be shored equally by you and the Agency. sO
Ifa written request For an administrative hearing is not timely received you will have waived
your right to hove the intended action reviewed pursuant to Chapter 120, Florida Statutes, and
the action set forth in the FAR shal] be conclusive and final
(Page & of 7}
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(Page 6 of 7}
Summary of Actua! Discrepancies Documented
No, Discrepancies
Cote
wo
Discrepancy Description
The claim for the prescription contains an Incorrect prescriber license number.
The number of refills billed and pald tc the pharmacy exceeds the number authorized by
prescriber, Refllis are dispensed without documented authorization from the prescriber,
Inapproprialely transferred prescription,
Tolal Overpayment
$396.49
{Page 7 cf 7)
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Docket for Case No: 07-001677MPI
Issue Date |
Proceedings |
Oct. 05, 2007 |
Final Order filed.
|
Jul. 11, 2007 |
Order Closing File. CASE CLOSED.
|
Jul. 11, 2007 |
Mare, Inc.`s Withdrawal of its Petition for Formal Hearing filed.
|
Jul. 09, 2007 |
Notice of Transfer.
|
Jul. 05, 2007 |
Proposed Pre-hearing Statement filed.
|
Jul. 05, 2007 |
Order Granting Motion to have Request for Admissions Deemed Admitted and Motion in Limine.
|
Jul. 02, 2007 |
Petitioner`s Motion in Limine and Incorporated Memorandum of Law filed.
|
Jul. 02, 2007 |
Motion to Have Request for Admissions Deemed Admitted filed.
|
Jun. 28, 2007 |
Petitioner`s Witness and Exhibit List filed.
|
Jun. 20, 2007 |
Order Granting Motion To Compel.
|
Jun. 13, 2007 |
Motion to Compel Discovery Responses filed.
|
May 02, 2007 |
Notice of Service of Interrogatories, Expert Interrogatories, Request for Admissions and Request for Production of Documents filed.
|
Apr. 24, 2007 |
Order of Pre-hearing Instructions.
|
Apr. 24, 2007 |
Notice of Hearing by Video Teleconference (hearing set for July 13, 2007; 9:00 a.m.; Miami and Tallahassee, FL).
|
Apr. 20, 2007 |
Joint Response to Initial Order filed.
|
Apr. 13, 2007 |
Initial Order.
|
Apr. 12, 2007 |
Final Audit Report filed.
|
Apr. 12, 2007 |
Petition for Formal Hearing filed.
|
Apr. 12, 2007 |
Notice (of Agency referral) filed.
|