PILE STATE OF FLORIDA - AHCA b AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY CLERK MN OCT -y > 2 go AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH CASE NO. 07-1977MPI C.L. No. 07-5280-000 vs. ; ‘ JUDGE: LINDA M. RIGOT : RENDITION NO.: AHCA-07- OloQ5yeS-MDES MARE, INC., d/b/a MARE PHARMACY ¢ DISCOUNT, Respondent. / FINAL ORDER soul vy S- Lol 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 Vet: , 2007, in Tallahassee, Florida. pox wih Cc. das J Secretary Viana 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 (nteroffice 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 J] 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 7” day of jalan 2007, 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 HEARIN Gs : 0 AGENCY FORBEALTH CARR UL 1.4 200? ADMINISTRATION, Petitioner, vs, oS CASE NO. 07-1677MPI MARE, INC. d/b/a MARE PHARMACY DISCOUNT Respondent. Se | 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 part, has been inappropriately paid by Medicaid. The Agency sought. recoupment of. this overpayment, in the amount of $195,5 15,89, a fine sanction of $5,000.00 for violation(s) of Rule 59G-9.070(7)(n) F.A.C.. In response 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. BA:eT AARE-GE-WL ” Mara, 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 MPT Teview, (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 thereafler 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 er.oT onetime ne * Mare, Inc, d/b/a Mare Discount Pharmacy Settlement Agreement 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 Tegulations. 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, 11. 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 ther, 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 “arid séttling 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. AT eT yARR ATE * Mare, Inc, d/b/a Mare Discount! Pharmacy Ne 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 it may be entitled by Jaw or Tules of the Agency regarding this Proceeding and any and all issues raised herein, PROVIDER further aprees 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 Tight 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, 19. This Agreement shall be in full force and effect upon execution by the respective Parties in counterpart. ATHT JARF-AS WIT Her2sanz Mare, inc. aya Mara Discount Pharmacy Satlement Agreement MARE, : Viva MARE DISCOUNT PHARMACY AGENCY For REALTa CARE TION 2727 Mahan Drive, Mail Stop #3 Tallabassee, FL 32308.5403 Dated: SV OF 2007 Dexter Assistant General Counsel} fasct atiet Lad a pee rT alee ot RBE-BE- TH . (Pane 4 of 7) FLCWUDA AGEH Ct FOR HEATH CARE ADAANS TRATION CHARLIE CRIST . ANDREW C. AGWUNOB!, M.D. SECRETARY GOVERNOR CERTIFIED MAIL No. 7004 2510 0001 4447 0593 March 2, 2007 Provider No.; 0224740 00 License No.: PH0009053 Ana Nelida Cabrera, President Mare, Inc, d/b/a Mare Pharmacy Discount 5350 Palm Avenue Hlaledh, FL 33012 In Reply Refer to .. FINAL AUDIT REPORT C1, No, 07-5280-000/P/KNEH Dear Ms, Cabrera: The Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Integrity, has completed a review of claims for Medicaid relmbursement for dales 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 hed determined you were overpnid $195,515.89, Based upon a review of all documentation submitied, we have determined that you were overpaid $195,515,89 for services that in whole or in part are not covered by Medicaid, A fine of 35,000 has been applied, The total amount due is $200,515,89, , Be advised of the Tollowing: (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 [or violations of federal and state Jaws, including Medicaid policy, This letier shall serve as notice of the follawing sunction(s): * A fine of $5,000 for violation(s) of Rule Section 59G-9.070(7)(n), F.A.C, is 2727 Muhan Drive, MBit 6 Feoripa Visil AHGA online ol Tallahassee, Florida 32308 COMPARE GARE hilpsfahce.myflorida.com * J agi WewsFtorldaGamparsCara.gov “iat? " (Page 2 of 7} Mare, Inc, d/bfa Mare Pharmacy Discount Case 07-5280-DO0/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, FS, 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 claims do not meet Medicaid requirements, The audit work papers arc attached, listing the claims that are affected by this determination, REVIEW DETERMINATION(S) The oudit included two reviews, 4 prescription medical records review and a purchase acquisition records review. The outcarne of both reviews determined the final overpayment duc as well as the sanctions imposed, : The audit included the review of a judgmental sample of selected 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 iternized listing of discrepancies noted in the review of the judgmental sample. : The audit included a comparison of your Jawful documented product acquisitions with your paid Medicaid claims. Only product acquisitions from 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 nyailable to dispense to Medicaid recipients. This review identified an overpayment of $195,515.89, Enclosed for this review arc the overpayment calculations which include the summary sheel(s),-pald claims data, and acquisition data, If you are currently involved in a bankruptey, you should notify your attorney immediately and provide a copy of this letter for them, Please advise your alorney that we need the following information immediutely; (1) the date of filing 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 atlorney, . (Page 3 of 7) Mare, Inc. d/b/a More Phormocy Discount Case 07-5280-O00/P/KNH Poge 3 . on If you are not in bankruptcy and you concur with our findings, remit by certified check in the umount of $200,515.89, which includes the overpayment amount as well as any fines imposed, The check must be payable to the Florida Agency for Health Care Administration, Questions regarding procedures for submitting payment should be directed to Medicaid Accounts Reecivable, (850) 488-5869. To ensure proper credil, be certain you legibly record on your check your Medicaid provider number and the C.!, 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 puy 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 Mcdicaid Program. Likewise, failure to comply with all sanctions applied or due dates may result in additional sanctions being imposed. You have the right to request a formal or informal hearing pursuant ta Section 120,569, F.S. 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 available. Ifa request for an Informal hearing }s made, the petition must be made in compliance with rule Sectlon 28-106,301, F.A.C, Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this letter, For more information regarding your hearing and mediation rights, please see the attached Notice of Administrative Hearing and Mediation Rights. : Any questions you may have about this matter should be directed to; Kathryn N, Holland, Senior Pharmacist, Agency for Healih Care Administration, Medleaid Program Integrity, 2727 Muhun Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 921- 1802, facsimile (850) 410-1972. : Sincerely, D beg D. Kenneth Yon AHCA Administrator Enclosure(s) cc; Benjamin R. Metsch The Metsch Law Firm, PA, (Page 4 of 7) ; fully below. More, Inc, Done d/b/a Mare Pharmacy Discount Case 07-52B0-000/P/KNH Page 4 NOTICE OF Ae te 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 (hercinafter FAR), you may request a formal administrative hearing pursuant to Section 120.97(1), Florida Statutes, [fF you do not dispute the facts stated in the FAR, but believe there are additional reasons to grant the relief you seek, you may request an informal administrative hearing pursuant to 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, os discussed more ‘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 revelved 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 for an administrative hearing is: Assistant Bureau Chief a Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Moil Stop #6 Talinhbassee, Floridan 32308 The request must be legible, on 8 4 by |1-Inch white paper, and contain; © 1. Your name, address, telephone number, any Agency identifying number on the FAR, if known, and name, address, and telephone number of your representative, if any; . 2, An explanation of how your substantial interests will be affected by the action described in the FARY 3. A statement of when and how you received the FAR; 4. For a request for formal hearing, a statement of all disputed issues of material fuct; 5. Fora request 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, whether you request mediation, if it is wvailable; 7, Fora request for informal hearing, what bases support an adjustment to the amount owed to the Agency; and 8. A demund for relief. \ A formal hearing will be hald if there ore disputed issues of material Fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a neutra) third party to assist the parties in e legal or administrative proceeding to rcuch a settlement of their case, If you and the Agency agree to fnediation, it does not mean that you Blve up the right to whearing, Rather, you and the ‘Agency. will try.to scttle your. case. first with mediation. : If you request mediation, and the Agency agrees to il, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement, If a mediation agreement is not reached within LO 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 agreement, unless Pie and the Agency agree to a different time period. The mediation agreement belween you and the Agency will include provisions for sclecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees thal must be ‘shared :equally by you and the Agency,-- pene . 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Bwoy sojseu9 TS" €'S'S bROS"Z «ESTE 606Z ooTe zgee°D 8 86zOss DE°TEGPT =-ZSTS ajnsdep Gwipng xaqea9 SB°S67‘OT BLTLY Este s6zE EEE wese-o 868 ESS Te-evast aes yajoeL Gus deopy Ee“2TT‘L PSTL°b = BOST zzez UvET zzee"O 8=—- OS BE BS"E90HT tse sayqe. Burp) ideapy LL°SSE'S zees-e = LOSe ELzL aoL’s SSE8°O 896 OLTT BS"EERbE 0846 snysig Oo/0S2 EADY eee :*CU a Sa ahEyDeAQ yUNAWAG afeyous saseyong paseysing [FOL Apewueyg jnowy pred PIeopayy nia feyqoL sGeisay.. aseyaund psyeiaig sijUp poled jo %E Se Aq dsig 4q : anaaayl BIESIPaW «SUP [BIOL PIFd SHUN sqnsay sIsA[euy Bd}OAU] Payesoid SOOZILEZ| -SOOZ/LO/LO = -POLS Mansy 00 Or2PeZ0 ~AQWNN JaplAdid qunoosig ADBWWeYd BeYY E/q/P “SU "BIEYY — “AWEN Japa (Page 6 of 7) Summary of Actual Discrepancies Documented No, Discrepancies (Code Discrepancy Description 1 WMO. The claim for the prescription contains an incorrec\ prescriber license number, The number of refills billed and pald ta the pharmacy exceeds the number authorized by 2 UR prasoribar, Refills ara dispensed without documented authorizalion from the prescriber. 1 MISC Inappropriately transferred prescription. Total Overpayment $396.49 (Paga7 of 7) Gesars saBreyueng |BOL OPER =| Wnouy Pied E}OL tS°SEb ‘OSIN ~ ISSEL O = eSorz080000 Bupzinoz Of DID SDISZIL GEZySOOSW oplevom)"osuory = EPESERO = PUI ‘apes, BIELSDOS. Be bt . un af lek 4 Desezosse2o Bwopiauy pe oOOf SoBLZG. LéeLbo0aW opaqodyy ‘anBpoy OOLESaO WOWEY “aUeLEpeWes EPLSESE/A 26b4t an do yrtt Mo 2BPEgECERDO Bwppyesyjonsabayy «2 «OD Ure SOIC . ZELGPODSW ponteyy ‘Kew-zenBupou: opgzneg §=—etieveg‘cARWeL = SELSU/bSL czy OWwM ig 447 8 asslypzoco0 Gust exakz 0 OO'DE SOBOZL LoRSSD0SW “TsoReD‘opefjen = 6 LzS0280 | Saar ZeIG ObzSELEte safuayueag spon dsuedaosyg pmowy iO aN Brug adidas ALB SOG fasueny aurey Jequasay ey awen wadpey = gt werdoey PIED séeg rajduieg jejuawiBpnr ~ Suysy] Aourdasosiq) DdOpZbz20 “ON Japlanig - ‘ . Aosuieyg rey Epyp Su] wey ARLE STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 07-1677MPI MARE, INC,, d/b/a MARE PHARMACY DISCOUNT, Respondent. ORDER CLOSING FILE This cause having come before the undersigned on Mare, Inc.'s Withdrawal of its Petition for Formal Hearing, filed July 11, 2007, and the undersigned being fully advised, it is, therefore, ORDERED that: 1. The final hearing in this cause scheduled for July 13, 2007, is hereby canceled. 2. The file of the Division of Administrative Hearings in the above-captioned matter is hereby..closed. DONE AND ORDERED this 11th day of July, 2007, in Tallahassee, Leon County, Florida. LINDA M. RIGOT © Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this lith day of duly, 2007. COPIES FURNISHED: Karen Dexter, Esquire Agency for Health Care Administration Fort Knox Building III, Mail Station 3 2727 Mahan Drive Tallahassee, Florida 32308 Lawrence R. Metsch, Esquire Metsch & Metsch, P.A. Aventura Corporate Center 20801 Biscayne Boulevard, Suite 307 Aventura, Florida 33180-1423

Docket for Case No: 07-001977