STATE OF FLORIDA F hes AGENCY FOR HEALTH CARE ADMINIS 4 me N19 Pi OPE EN 1 P53 SOUTHEAST PERSONNEL LEASING AND LION INSURANCE COMPANY, INC., ADMINISTER sive HEARINGS Petitioners, DOAH CASE NO. 07-3562 _AHCA NO. 2007008407 v. DETERMINATION NO. 20070503-003 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioners filed on July 30, 2007. On August 2, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On November 13, 2007, the Petitioners filed a Notice of Voluntary Dismissal, stating that the parties had resolved the dispute. On November 19, 2007, the ALY 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 Petitioners’ Petition is dismissed with prejudice and the Agency’s June 18, 2007, Determination is hereby upheld. Unless they have already done so, Petitioners shall submit the correct reimbursement amount as stated in the Agency’s June 18, 2007, Determination to University Community Hospital within 30 days of the date that this final order is rendered, and shall submit proof ‘of reimbursement to: Ms. Twan Jackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this 4 KH day of ¢ ed. LY , 2008, in Tallahassee, Florida. HOLLY BENSON, Sectet: Y/ AGENCY 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 I 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 [7 day of . Jare__,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: Daniel Manry Mari H. McCully, Esquire Administrative Law Judge Department of Financial Services Division of Administrative Hearings Division of Workers’ Compensation The DeSoto Building 200 East Gaines Street 1230 Apalachee Parkway Tallahassee, Florida 32399-4229 Tallahassee, Florida 32399-3060 Timothy L. Newhall, Esquire Jan Mills Law Offices of Timothy L. Newhall, L.L.C. Facilities Intake 1334 Timerlane Road, Suite 11 Tallahassee, Florida 32312 Robert A. Vigh, Esquire Elizabeth Dudek Solomon, Ginsberg, and Vigh, P.A. Health Quality Assurance Post Office Box 3275 Tampa, Florida 33602-3275 . Annemarie Craft, Esquire University Community Hospital Stiles, Taylor & Grace, P.A. Post Office Box 1140 Tallahassee, Florida 32302 Post Office Box 404135 Atlanta, Georgia 30384-4135

Docket for Case No: 07-003562