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AGENCY FOR HEALTH CARE ADMINISTRATION vs LAZARO N. PLASENCIA, M.D., 07-002195MPI (2007)

Court: Division of Administrative Hearings, Florida Number: 07-002195MPI Visitors: 25
Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: LAZARO N. PLASENCIA, M.D.
Judges: J. D. PARRISH
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: May 16, 2007
Status: Closed
Recommended Order on Tuesday, April 1, 2008.

Latest Update: May 13, 2008
Summary: Whether the Respondents were overpaid by Medicaid for radiology and nuclear medicine services provided to Florida Medicaid patients. The Agency for Health Care Administration (AHCA, Agency or Petitioner) asserts that the Respondents, Lazaro N. Plasencia, M.D., and Ana M. Elosegui, M.D., billed Medicaid for procedures they did not perform in violation of Medicaid policy, the Florida Administrative Code, and Florida Statutes. The Respondents maintain that because of ambiguities in Medicaid policy
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STATE OF FLORIDA ‘ 9 CLERK AGENCY FOR HEALTH CARE ADMINISTRA * gfe 13 A 83 RENDITION NO.: AHCA-08- 0414 -FOF-MDO “f° STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, DOAH CASE NO. 07-2195MPI Petitioner, AUDIT NO. C.I. 06-4359-000 v. LAZARO N. PLASENCIA, M.D., Respondent. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, DOAH CASE NO. 07-2462MPI Petitioner, AUDIT NO. C.I. 06-4358-000 Vv. ANA M. ELOSEGUI, M.D., Respondent. / FINAL ORDER This case was referred to the Division of Administrative Hearings (DOAH) where the assigned Administrative Law Judge (ALJ), J.D. Parrish issued a Recommended Order after conducting a formal hearing. At issue in this proceeding is whether the Respondents were overpaid by Medicaid for radiology and nuclear medicine services provided to Medicaid patients. The Recommended Order dated April 1, 2008, is incorporated herein by reference. RULING ON EXCEPTIONS The parties did not file any exceptions to the Recommended Order. FINDINGS OF FACT The Agency adopts the findings of fact set forth in the Recommended Order. CONCLUSIONS OF LAW The Agency adopts the conclusions of law set forth in the Recommended Order. IT IS THEREFORE ADJUDGED THAT: In DOAH Case No. 07-2195MPI, Respondent Lazaro N. Plasencia, M.D. (“Dr. Plasencia”) is required to repay $196,129.52 in Medicaid overpayments, plus statutory interest, to the Agency for paid claims covering the period from July 1, 2001 to December 31, 2005. Additionally, the Agency imposes a $1,000 fine on Dr. Plasencia. Dr. Plasencia shall make full payment of the overpayment, costs and fine to the Agency for Health Care Administration within 30 days of the rendition of this Final Order. Dr. Plasencia shall pay by check payable to the Agency for Health Care Administration and mailed to the Agency for Health Care Administration, Office of Finance and Accounting, 2727 Mahan Drive, Fort Knox Building 2, Mail Stop 14, Tallahassee, Florida 32308. In DOAH Case No. 07-2462MPI, Respondent Ana M. Elosegui, M.D. (“Dr. Elosegui”) is required to repay $122,065.08 in Medicaid overpayments, plus statutory interest, to the Agency for paid claims covering the period from October 11, 2002 to December 31, 2005. Additionally, the Agency imposes a $1,000 fine on Dr. Elosegui. Dr. Elosegui shall make full payment of the overpayment, costs and fine to the Agency for Health Care Administration within 30 days of the rendition of this Final Order. Dr. Elosegui shall pay by check payable to the Agency for Health Care Administration and mailed to the Agency for Health Care Administration, Office of Finance and Accounting, 2727 Mahan Drive, Fort Knox Building 2, Mail Stop 14, Tallahassee, Florida 32308. DONE and ORDERED this 22 day of Auk y , 2008, in Tallahassee, Florida. prot BENSON, Teen Le ENCy FOR 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 J HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this [S day of VA “Boye , 2008. es RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: J.D. Parrish Administrative Law Judge Division of Administrative Hearing The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 L. William Porter, II, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Robert M. Penezic, Esquire Broad and Cassel Post Office Box 14010 Fort Lauderdale, Florida 33302-4010 Robert N. Nicholson, Esquire Broad and Cassel Post Office Box 14010 Fort Lauderdale, Florida 33302-4010 Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS #4 Fort Knox Building ITI Tallahassee, Florida 32308 Henry Evans Finance & Accounting

Docket for Case No: 07-002195MPI
Issue Date Proceedings
May 13, 2008 Final Order filed.
Apr. 01, 2008 Recommended Order (hearing held December 17, 2007). CASE CLOSED.
Apr. 01, 2008 Recommended Order cover letter identifying the hearing record referred to the Agency.
Feb. 26, 2008 Respondents` Proposed Recommended Order filed.
Feb. 25, 2008 State of Florida, Agency for Health Care Administration`s Closing Argument and Proposed Recommended Order filed.
Jan. 23, 2008 Order Granting Extension of Time (proposed recommended orders to be filed by February 25, 2008).
Jan. 17, 2008 Joint Motion for 30 Day Enlargement of Time filed.
Jan. 04, 2008 Transcript filed.
Dec. 19, 2007 Prehearing Stipulation filed.
Dec. 17, 2007 CASE STATUS: Hearing Held.
Dec. 14, 2007 Respondent`s Witness and Exhibit List filed.
Dec. 12, 2007 Petitioner`s Witness and Exhibit List filed.
Dec. 04, 2007 Notice of Additional Counsel filed.
Dec. 03, 2007 Joint and Agreed Motion for Official Recognition filed.
Nov. 14, 2007 Order of Consolidation (DOAH Case Nos. 07-2195MPI and 07-2462MPI).
Oct. 01, 2007 Notice of Hearing (hearing set for December 17, 2007; 9:00 a.m.; Tallahassee, FL).
Sep. 28, 2007 Joint Status Report filed.
Aug. 24, 2007 Order Requiring Status Report (status report shall be filed by September 28, 2007).
Aug. 24, 2007 Status Report filed.
Jul. 19, 2007 Order Granting Continuance (parties to advise status by August 20, 2007).
Jul. 18, 2007 Unopposed Motion for Continuance filed.
Jun. 13, 2007 Order of Pre-hearing Instructions.
Jun. 13, 2007 Notice of Hearing (hearing set for August 6, 2007; 9:00 a.m.; Tallahassee, FL).
Jun. 04, 2007 Joint Status Report filed.
May 16, 2007 Order Re-opening File.
May 15, 2007 Motion to Re-open filed. (FORMERLY DOAH CASE NO. 07-0101MPI)
Jan. 09, 2007 Final Audit Report filed.
Jan. 09, 2007 Petition for Formal Administrative Hearing filed.
Jan. 09, 2007 Notice (of Agency referral) filed.

Orders for Case No: 07-002195MPI
Issue Date Document Summary
May 13, 2008 Agency Final Order
Apr. 02, 2008 Recommended Order Recoup of overpayment is established where the Respondent showed that the physicians are not entitled to bill for global service when they only performed technical component of the item.
Source:  Florida - Division of Administrative Hearings

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