STATEOF FLORIDA FILED AGENCY FOR HEALTH CARE ADMINISTRATION Orthopedic Specialists of SW Florida, Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. 2808 JUN 19 Pas og 17 2 i hb OiVISION GF ADMINIS TRAT ye DOAH CASE NO. 0725708105 AHCA NO. 2007009049 DETERMINATION NO. 20070503-012 FINAL ORDER THIS CAUSE concerns a Petition for Formal Administrative Hearing (“Petition”) that the Petitioners filed on August 14, 2007. On August 16, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On October 2, 2007, the Petitioner filed a Hearing Withdrawl Request, stating that the Petitioner had received correct reimbursement. On October 3, 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 July 25, 2007, Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s July 25, 2007, Determination to The Hartford Medical Management Center 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 /@ aay of Gece , 2008, in Tallahassee, Florida. HOLLY BENSON, =o fet 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 Tre _ , 2008. PP aaZz SO = Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Daniel M. Kilbride Administrative Law Judge ’ Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Catrina N. Ramage 2531 Cleveland Avenue Suite 1 ‘ Fort Myers, Florida 33901 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 The Hartford Medical Management Center P.O. Box 14214 Lexington, Kentucky 40512 . Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance

Docket for Case No: 07-003700