STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, Ol . SY x (4 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2007008055 LAKESHORE SYSTEM SERVICES OF FLORIDA, INC. d/b/a HEALTHSOUTH EMERALD COAST REHABILITATION HOSPITAL, Respondent / ADMINISTRATIVE COMPLAINT Petitioner, the Florida Agency for Health Care Administration (“AHCA”), through undersigned counsel, files this Administrative Complaint against the above named Respondent (“Respondent”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2005)', and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $97,345 (the “Fine Amount”) against Respondent, per Sections 408.034 and 408.040, Florida Statutes and Florida Administrative Code Rules 59C-1.013 and 59C-1.021. 2. For the calendar year 2005 (the “Calendar Year”), Respondent failed to comply with the minimum of four point three percent (4.3%) of the total annual patient days in the 75- bed facility shall be provided to charity care patients condition upon its Certificate of Need (“CON”) (Exhibit “A”). ‘Unless otherwise noted, all Statutes and rules hereinafter cited are to the indicated year’s version of the statute or rule, because this is the controlling year in question. Page 1 of 11 JURISDICTION AND VENUE 3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031-408.45, Florida’s “Health Facility and Services Development Act.” 4. Venue is determined by Florida Administrative Code Rule 28-106.207. PARTIES 5. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to a comprehensive medical rehabilitation facility laws and rules. 6. Respondent is a corporation authorized under the laws of Florida to do business. Respondent operates a comprehensive medical rehabilitation hospital located at 1847 Florida Avenue, Panama City, Florida 32405, and is the licensee on the CON issued on January 18, 2003, to add 10 comprehensive medical rehabilitation beds to the existing 65-bed freestanding comprehensive medical rehabilitation hospital in Bay County with the condition that a minimum of four point three percent (4.3%) of the total annual patient days in the 75-bed facility shall be provided to charity care patients. The certificate number is CON #9598, a copy which is attached to this Complaint as Exhibit “A”. COUNT I (Respondent failed to meet Its Minimum Charity Care Patient Condition) Section 408.040, Florida Statutes Rule 59C-1.013, Florida Administrative Code Rule 59C-1.021, Florida Administrative Code 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above. Page 2 of I1 8. Respondent filed an annual compliance report, which reflected that the facility did not comply with the Minimum Charity Care Patient Condition for the Calendar Year 2005 (Exhibit “B”’), based on the following findings: The facility report indicated that the facility provided one point ninety-six percent (1.96%) of its total annual patient days to Charity Care Patients. 9. Respondent failed to comply with the condition set forth in its CON, as required by Sections 408.034 and 408.040, Florida Statutes; and Rule 59C-1.013, Florida Administrative Code which provide in part as follows: 408.040 Conditions and monitoring (1)(@) The agency may issue a certificate of need predicated upon statements of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need based on such statements of intent shall be stated on the face of the certificate of need. (b) The agency may consider, in addition to the other criteria specified in s. 408.035, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utilized by patients eligible for care under Title XIX of the Social Security Act. Any certificate of need issued to a nursing home in reliance upon an applicant's statements that a specified percentage of annual patient days will be utilized by residents eligible for care under Title XIX of the Social Security Act must include a statement that such certification is a condition of issuance of the certificate of need. The certificate-of-need program shall notify the Medicaid program office and the Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented. Page 3 of 11 (c) A certificate holder may apply to the agency for a modification of conditions imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need demonstrates good cause why the certificate should be modified, the agency shall reissue the certificate of need with such modifications as may be appropriate. The agency shall by rule define the factors constituting good cause for modification. (d) If the holder of a certificate of need fails to comply with a condition upon which the issuance of the certificate was predicated, the agency may assess an administrative fine against the certificate holder in an amount not to exceed $1,000 per failure per day. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance. *** 59C-1.013 Monitoring Procedures (4) Reporting Requirements Subsequent to Licensure or Commencement of Services. All holders of a certificate of need that was issued predicated upon conditions expressed on the face of the certificate of need shall provide annual compliance reports to the agency. The reporting period shall be January 1 through December 31 of each year. The holder of a certificate of need who began operation after January 1 will report from the date operation began through December 31. The compliance report shall be submitted no later than April 1 of the subsequent year. (a) The compliance report will contain information necessary for an assessment of compliance with conditions on the certificate of need, utilizing measures, such as a percentage of patient days, that are consistent with the stated condition. The following information shall be provided in the holder’s annual compliance report: 1. The time period covered by the measures; 2. The measure for assessing Page 4 of 11 compliance with each of the conditions identified and described on the face of the certificate of need; 3. The way in which the conditions were evaluated by applying the measures; 4. The data sources used to generate information about the conditions that were measured; 5. The person and position responsible for supplying the compliance report; 6. Any other information necessary for the agency to determine compliance with conditions; and 7. If applicable, the reason or reasons, with supporting data, why the certificate of need holder was unable to meet the conditions set forth on the face of the certificate of need. (b) A change in the licensee for a facility or service does not affect the obligation for that facility or service to continue to meet conditions imposed on a certificate of need and to provide annual condition compliance reports. (c) Conditions imposed on a certificate of need may be modified consistent with Rule 59C-1.019, F.A.C. (5) Violation of Certificate of Need Conditions. Health care providers found by the agency to be in noncompliance with conditions set forth in their certificate of need shall be fined as defined in Rule 59C-1.021, F.A.C. 10. The foregoing violation warrants imposition of the above-mentioned Fine Amount pursuant to Rule 59C-1.021, Florida Administrative Code which provides in part: 59C-1.021 Penalties. (1) General Provisions. The agency shall initiate administrative proceedings for revocation of a certificate of need for violation of paragraphs 408.040(2)(a) and (b), F.S., or the assessment of administrative fines for failure to comply with conditions placed on a certificate of need as specified under Rule 59C-1.013, F.A.C. Page 5 of 11 (3) Penalties for Failure to Comply with Certificate of Need Conditions. The agency shall review the annual compliance report submitted by the health care providers who are licensed and operate the facilities or services and other pertinent data to assess compliance with certificate of need conditions. Providers who are not in compliance with certificate of need conditions shall be fined. For community nursing homes or hospital-based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions must be submitted 30 calendar days following the eighteenth month of operation or the first month where an 85 percent occupancy is achieved, whichever comes first. The schedule of fines is as follows: (a) Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a fine, not to exceed $1,000 per failure per day. In assessing the penalty the agency shall take into account the degree of noncompliance. (b) The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an administrative hearing has been requested. If a health care provider desires it may remit payment according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments to the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 calendar days after final agency action. The final balance will be due no later than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 months after final agency action. Page 6 of 11 11. AHCA, in determining the penalty imposed, considered the degree of non- compliance by the Respondent. WHEREFORE, AHCA demands the following relief (1) enter factual and legal findings as set forth in this Count; (2) impose the above-mentioned Fine Amount for the violation; and (3) impose such other relief as this tribunal may find appropriate. NOTICE RESPONDENT is hereby notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Clerk. RESPONDENT IS FURTHER NOTIFIED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. Submitted as of the date indicated on the below Certificate of Service. F (nee iypfos Senior Attomey Fla. Bar No. 0355712 Agency for Health Care Administration 2295 Victoria Avenue, Room 356C Fort Myers, Florida 33901 Phone: (239) 338-3209 Facsimile: (239) 338-2699 Page 7 of 11 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail, Return Receipt Requested (receipt #7006 2150 0004 5871 0774) to Respondent, Lakeshore System Services of Florida, Inc., d/b/a HealthSouth Emerald Coast Rehabilitation Hospital, Attention: Administrator, 1847 Florida Avenue, Panama City, Florida 32405; Registered Agent, CT Corporation System, 1200 S. Pine Island Road, Plantation, Florida 33324 (receipt #7006 2150 0004 5871 0781), and Deborah S. Platz, Attorney for Respondent, Panza, Maurer and Maynard, P.A., 3600 North Federal Highway, Bank of America Building, Third Floor, Fort Lauderdale, Florida 33308 (receipt #7006 2150 0004 5871 0767) this gSMlay of 2007. Getta i fe Senior Attorney Copies furnished to: _— Administrator Lakeshore System Services of Florida, Inc. d/b/a HealthSouth Emerald Coast Rehabilitation Hospital 1847 Florida Avenue Panama City, Florida 32405 Certified U.S. Mail) Mary Daley Jacobs Senior Attomey Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) Registered Agent CT Corporation System 1200 S. Pine Island Road Plantation, Florida 33324 (Certified U.S. Mail) James McLemore Unit Manager Certificate of Need Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #28 Tallahassee, Florida 32308 (Interoffice Mail) Deborah S. Platz Attorney for Respondent Panza, Maurer and Maynard, P.A. 3600 N. Federal Highway Bank of America Building, Third Floor Fort Lauderdale, Florida 33308 (Certified U.S. Mail) Page 8 of 11 EXPLANATION OF RIGHTS UNDER SECTION 120.569, FLORIDA STATUTES (To be used with the attached Election of Rights form) In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (‘AHCA” or “Agency”), Respondent must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint and your Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date you receive the Administrative Complaint. Please make your election on the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION 1, . If Respondent does not dispute the allegations in the Administrative Complaint and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. If Respondent does not dispute any material fact alleged in the Administrative Complaint (Respondent admits all the material facts alleged in the Complaint.), Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, Respondent will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, Respondent should select OPTION 2 on the Election of Rights form. OPTION 3. If the Respondent disputes the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., Respondent’s request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts disputed. IF YOU SELECT OPT, 3, CAREFULLY READ THE FOLLOWING PARAGRAPH: In order to preserve the right to a hearing, Respondent’s Election of Rights in this matter must be RECEIVED by AHCA within 21 days from the date Respondent receives the Administrative Complaint. If the election form with Respondent’s selected option is not received by AHCA within 21 days from the date of Respondent’s receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. Page 9 of 11 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: HealthSouth Emerald Coast Rehabilitation Hospital Case No. 2007008055 ELECTION OF RIGHTS FOR ADMINISTRATIVE HEARING PLEASE SELECT ONLY 1 OF THE 3 OPTIONS (An Explanation of Rights form is attached) OPTION _ONE (1) c Respondent does not dispute the allegations of fact contained in the Administrative Complaint and waives Respondent’s right to object or to be heard. Respondent understands that by waiving Respondent’s rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) 5 Respondent does not dispute and Respondent admits the allegations of fact in the Administrative Complaint, but Respondent does wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time Respondent will be permitted to submit ora] and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) 0 Respondent does dispute the allegations of fact contained in the Complaint and Respondent requests a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings (“DOAH’). If Respondent chooses OPTION (3), in order to obtain a formal proceeding before the DOAH under Section 120.57(1), Florida Statutes, Respondent’s request for a hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. If you select Option 3, mediation may be available in this case pursuant to Section 120.573, Florida Statutes, if the Agency agrees to it. In order to preserve Respondent’s right to a hearing, Respondent’s Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date Respondent receives the Administrative Complaint. If the election of rights form with Respondent’s selected option is not received by AHCA within twenty-one (21) days from the date of the Respondent’s receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. If Respondent has elected either OPTION (2) or THREE (3) above and if Respondent is interested in discussing a settlement of this matter with the Agency, please also mark and check this block. a Mediation under Section 120.573, Florida Statutes, is not available in this matter, SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL RESPONDENT RECEIVES A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Agency for Health Care Administration, Office of the General Counsel, Attention: Agency Clerk, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308. Telephone Number: 850-921-8177; FAX 850-921-0158; TDD 1-800-955- 8771. Page 10 of 11 EXHIBITS (AHCA v. Lakeshore System Services of Florida, Inc. d/b/a HealthSouth Emerald Coast Rehabilitation Hospital, Case No. 2007008055) EXHIBIT “A” - Respondent’s CON #9598 requiring that a minimum of four point three percent of the total annual patient days in the 75-bed facility be provided to charity care patients. EXHIBIT “B” - Respondent’s Annual Compliance Report for Year 2005. (All are copies.) Page 11 of 11 PAGE 82 CON 858-922-6964 10/22/2687 @8:83 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CERTIFICATE OF NEED Under the provisions of the "Health Facility and Services Development Act® (Sections 408.031-.045, Florida Statutes AND Chapter 59G-1, Florida Administrative Code), the Agency for Health Care Administration certifies the need for this project. NUMBER: 9598 APPLICANT: - . : Lakeshore System Services of Florida, Inc. PROJECT COST:_$2,086,464 dfb/a HealthSouth Emerald Coast Rehabilitation Hospital ISSUE DATE: __January 18, 2003 One HealthSouth Parkway TERMINATION DATE:__ July 47, 2004 Birmingham, Alabama 35243 REVISED TERMINATION DATE: COUNTY: Bay DISTRICT: SUBDISTRICT: PROJECT DESCRIPTION: Add 10 comprehensive medical rehabilitation (CMR) beds to the existing licensed 65 beds at HealthSouth Emerald Coast Rehabilitation Hospital, creating a 75-bed CMR hospital. The project involves 5,500 GSF of new construction and construction costs of $1,407,500. CONDITIONS: (1) Aminimum of 3.2 percent of the total annual patient days in the 75 CMR beds shall be provided to Medicaid patients; and (2) A minimum of 4.3 percent of the total anpudl patient days in the 75 CMR beds shall be provided to charity patients. FORM 1793, APRIL 1993 pate:_// a 2 [a 3, . 69/21/2007 13:04 858-322-6964 CON PAGE” G6 ” HEALTHSOUTH Emerald Coast Rehabilitation Hospital July 17, 2006 ECEIVEr JUL 19 2006 James B. McLemore ; Agency for Health Care Administration. Con/Financial Analysis Office 2727 Mahan Drive _ Mail Stop 28 Mail Stop #28 Tallahassee, Florida 32308 RE: HEALTHSOUTH Emerald Coast Rehabilitation Hospital CON 8959, 9221, 9598 Conditions: Minimum of 3.2% of the total patient days shall be provided to Medicaid patients and a minimum of 4.5% of the total patient days shall be provided to charity patients, and an 8 Bed Brain & Spinal Cord program shall be maintained. Dear Mr. McLemore: Pursuant to Subsection 59c-1.013 (4)(d}, Florida Administrative Code, this letter represents the condition compliance report for the referenced certificate of need: 1. Time period covered by the measure. January 1, 2005 through December 31, 2005 2, Measure for assessing compliance of the condition identified and described. . ; Total patient days: 18,565 3. Way in which the conditions were evaluated by applying the measure. 658 Medicaid Patient Days / 18,565 Total Patient Days = 3.54% ; 658 Medicaid Patient Days / 3,115 Non-Medicare Patient Days = 21.12% 363 Charity Patient Days/ 18,565 Total Patient Days = 1.96% 363 Charity Patient Days / 3,115 Non-Medicare Patient Days = 11.65% 4. Actual data sources used to generate the jnformation on the condition to be measured. The actual data sources used were the Fiscal year erided December 31, 2005 Patient Accounting System Census Reports and Account details. BYY “Poms one EXHIBIT la 1847 Florida Avenue - Panama City. FL 32408 - 850 $14-8632 - Fax 850 914-3783 ~ O9/21/2097 13:84 850-322-6964 cON . PAGE 67 HEALTH SOUTH Emerald Caast Retabittation Haspitai 5. The source of the data for the measure. The sources of the data were the Fiscal year ended December 31, 2005 Patient Accounting Systems Census Reports and Account details from the Patient Accounting System. . Reasonableness of the measures and confidence in measures. The measure used to calculate compliance with the CON conditions is the generally accepted approach to measuring a percentage of patient days attributable to specific payors. We are confident in the data reported because it ties to the Hospital's billing records and general ledger totals. . Person and position responsible for defining measures and supplyin compliance report. Angela Eddins, Accounting Manager Tony Bennett,.CEO . Any information necessary to determine compliance with the condition. At HealthSouth Emerald Coast Rehabilitation Hospital, there is a full, good faith effort to comply with all. CON requirements. It is our policy to accept any patients who are medically appropriate for rehabilitation, when open beds are available. This policy is applied regardless of the patient’s financial coverage or the ability to pay. - Reasons, with supporting data, why the certificate of need holder was unable to meet one of the conditions set forth on the face of the certificate of need. As a specialty designated rehabilitation hospital, at HealthSouth, we are licensed to treat specific clinical criteria for admission (in addition to diagnostic requirements). These clinical criteria include: appropriateness of admission and ability to progress, benefit in/from rehabilitation services, and established disposition upon discharge. These criteria apply to all payor types, including Medicaid and indigent. While working within these stated criteria, our hospital surpassed the requirement of 3.2% Medicaid patient days by actually providing 3.54% of our total patient days to Medicaid patients. - We also maintained an 8 bed Brain and Spinal Cord Program as referenced on our floor plan. During 2005, 47 defined charity referrals resulted in, 26 charity admissions. Of the 21 potential charity patients who were not admitted: : © 8 refused admission and chose to go to a skilled nursing facility, or to go home with home health or outpatient services 1847 Florida Avenue - Panama City, FL 32408 + 950 914-8632 + Fax ASO 914-8788 . 2 Q9/21/2887 13:84 850-922-5364 COM PAGE 88 HEALTHSOUTH Emerald Coast Rehabiltation Hospital o 13 were inappropriate for admission based on requirements for a licensed rehabilitation facility None were turned away due to their lack of funding.or their inability to pay. The patient days and referrals listed above are for Non-Medicare patients. While many Medicare patients may have Medicaid or be considered indigent, they are | only considéred as Medicare for our calculations. ‘Medicare patient days made up 83% of the total patient days at this facility for. 2005. From the remaining 17% of total patient days, 21.12% were Medicaid and 11.65% were charity; both exceeding the requirements when considering only Non-Medicare patients. Consistent with the Florida Administrative Code, section 59C-1.013(3) c, we believe we have complied in good faith, as best as the market can deliver, compliance with the Medicaid and charity care patient days available and ad presented to our hospital. Our intemal calculations clearly demonstrate good faith effotts in accepting all indigent and Medicaid patients referred and who have met criteria and who accepted and agreed to come to this facility. HEALTHSOUTH Emerald Coast Rehabilitation Hospital will continue to serve al patient populations and strive to meet or exceed the CON requirements. If further information is required, please feel free to contact me at (850) 914- 8603. Thank you. Sincerely, Angie Cdn, Angela Eddins Accounting Manager and Authorized Representative of CON Holder and Licensee HEALTHSOUTH Emerald Coast Rehabilitation Hospital 1847 Florida Avenug - Panama ory. FL 22405 + 850 914-8632 » Fax 850 914-2799 3 93/21/2887 13:64 958-922-6964 - ON ‘ald Coast Rehabilitation Hospital Facility Name: , itatie ° MealEARIESOUTH Medicaid Eligible Days Log Medicare Provider #: State ; Medicaid Discharge Primary (P) Medjcaid #,3f © FYE 2005 GiL Cot Program Patieot # Admit Date Date or Other (0. _ Primary Eligible Days MEDICAID ELIGIBLE - NOT BILLED TO MEDICAID OR MEDICARE MEDICAID PRIMARY BILLED AS/TO MEDICAID (Included as MEDICAID ON COST PKG TOTALS) 10-2750 FL $964238 12/22/2004 17472005 2624990233 3 10-2750 FL 1964006 12/17/2004 1/§/2005 1960886029 4 10-2750 FL - 1965144 1/18/2005 - 1/26/2005 8141046641 8 10-2750 FL 1965102 1/18/2003 1/27/2005 7335654327 x) 10-2750 FL 1964980 1/14/2005 —«*1/28/2005 7336203922 14 10-2750 FL 1965458 1/28/2005 2/5/2008 $104300300 8 10-2750 FL 1965896 2/7/2008 ~—-2/14/2005 718090371 7 10-2750 FL, 1965375 1/26/2005 2/16/2005 8118696189 2 10-2780 FL (965979 2/9/2008 2s 7/2005 7850498232 8 10-2750 FL 1966407 2/23/2005 11/2005 7346219376 16 40-2750 PL 1966845 3/9/2005 3/4 6/2N05 YSISS14113 . 7 10-2750 FL 1966688 3/7/2005 + =—-3/19/2005 1960965026 12 19-2750 FL . 1966944 3/11/2005 3/24/2005 8104408542 13 10-2750 FL 1966431 2/25/2005 3/9/2005 8292145040 12 10.2750 FL 196718? 3/46/2005 4/1/2005 2638061506 16 10-2750 FL 1967454 3/25/2005 4/12/2005 - ; 8212371891 18 10-2750. FL - 1967140 3/16/2008 4/12/2008 8135637616 / a7 10-2750 Fl. 1967879 3/28/2005 4/8/2005 7919332664 i 10-2750 FL 1967645 3/31/2005 4/17/2005 7801840771 7 10-2750 FL 1967959 4/13/2005 4/18/2005 81342335760 5 10-2750 FL 1967850 4/8/2005 4/20/2005 7395567297 12 10-2750 FL 1967900 4/11/2005 5/3/2005 8207064129 22 10-2750 FL 1968304 4/26/2005 $/3/200S 8129767422 7 10-2750 FL 1968411 4/29/2005 5/5/2003 8452259349 6 10-2780 PL 1968288 4/25/2005 5/9/2005 7595367297 14 10-2750 FL "+ 1968987 s/10/2005 =—-5/21/2005 8177091808 ; NW 10-2750 FL 1969575 $/27/2005 6/9/2005 7785039950 3 10.2750 FL 1969708 6/3/2005 6/10/2005 2168642028 7 10-2750 FL 1969997 6/13/2005 6/21/2005 2527678874 8 10-2750 FL 1969963 - 6/13/2005 #812005 3003938026 22 10-2750 FL 1970409 6/23/2005 7/6/2005 8110622372 13 10-2750 FL 1970656 6/29/2005 TABZ200S 7675380894 14 10-2750 FL. 1970995 7/11/2005 = 7/20/2008 1655736375 . 9 “19-2750 FL 1971373 7/21/2008 PAIS 7691136588 3 10-2750 FL 1969815 6/9/2005 1/3/2005 7441689589 26 10-2750 FL 1971530 7/26/2005 8/2/2005 "8236500853 ? 19-2750 FL 1971878 8/3/2905 8/13/2005 8202145040 10 10-2750 FL 1971738 7/3072008 ~—«8/16/2008 8195843433 19 10-2780 FL 1971654 7/29/2905 8/19/2005 §192330176 21 10-2750 -FL 1972272 8/16/2005 $/2.6/2005 7788039950 19 10-2780 FL 1973015 9/14/2008 9/27/2005 1855275121 ‘3 10-2750 FL 1972991 9/14/2008. 9/28/2005 + 8223654199 fa 10-2750 FL 1972348 8/19/2005 9/9/2005 7450474743 Pal 10-2750 FL 1972512 8/30/2008 9/15/2005 7406005342 16 10-2750. FL 1973528 9/29/2008 —-L 9/4/2008 7655736375 _7 10-2750 FL . 1973536 9/30/2005 10/17/2008 7339471855 7 10-4750 FL 1973965 10/12/2008 10/20/2005 7485147889 8 10-2750 FL 1973767 10/8/2005 10/31/2003 6666574836 23 10-2759 FL 1975101 41/12/2005" 11/18/2005 1085716023 6 40-2780 FL 1975457 1172272005 12/8/2005 2612348557 16 19-2750 PL 1975440 1122/2008 — 12/19/2005 7412595571 27 MEDICAID PRIMARY NOT BILLED AS/TO MEDICAID (No Remaining Days, Etc.) One 1 Total 658 PaGe 63 7/17/2006 18 PAGE 284 13 93/21/2887 858-922-6364 ee See Lh ge ESS C3 zatsw'ris Bh e9z'aI4 LEO ZT paver aet £5 vO9'01$ sess reoov'alt WS LAT ELS CL PET OLE LZ VETS la ece1zs eS ore'cis peace hts peeaeud arewe 4 See td Ira Si zae1zs IPoys FLGLO'OZS OF '216'S7S BC RZ 629 7 95E S79 HOES US oes oos 000s ons SEE ZS 98085 973 ZPLSH HIS epazod LOL po 1Le'eZt 15° OB3'O1F SESH SIS PEON BIS 1G°202'G1T TE RET ONS LZ LeB VS PL o9L 1s ZY TOSS SLRTL PS Lerree'es. Suzea'izt besarte vesioazt ar ree'szt Se Sune a PERs SPU su sruFuULuss Pestez SPesSHoL ESSE OSSt Pt Ore ZrOULse ALGAE . SLUT GPELTUZS TESISS SOULE FSO IPE Z9BILE SOBLILICT GLGLEUE ZrERGUC | OP6UZU8 LGLsPas ase LEONE SLGMUSUF LLG MOE GrOUSsEE 6c] Queuy PAD EAwWAQauwasusoxonoyvasyst 238 AOU SoG ueZh SOOZ/FZ/EE suze SOOZOLILE SO0Z7L004 DOVES soon OZZS SOTA SOD zs sooesze soverut SOnzte Le S002th9 SOLES sooz IS ROOUUTI SOOT SOTUIEED SOOM s0UZ1 PONTO SOOTHE SADT LE SUOTISIS SOOLEL sanwaee SOOUTNL $002887/9 SOOuLS . SOOULEIS S002 845 sno SOLS HATE soe sway SDE sOoU MOLT scozrin sezzcoL YETLNOD 4212091 Ors 200b OL0L008 LESONOL 2089001 P6t.900) zcas00h £s@00} 9214001 e900) $8900! $9Z001 rsLo001 9212001 isoodoy czoeda1 oresoat oleson 0522-01 O50! DIZ OSZ01 OZ Oizo ONE O5L2-08 G5L2-08 Osc aMeor OLS asi2-OL OrL2-O1 Oslz-0b OLE OL OrL2-OL OF22-01 LogSes) Leggeeh O0zsL6) renSZeL ZYSPEEL WO@ELet WSGLAGh LOZZL6L E161 rAverdiy COGS LGL HOLLEL 83/21/2887 13:64 858-922-6364 CON | . PAGE {1 i gras 2 HEALTHSOUTH Emerald Coast Renan, Yngpen AO Sed Aecmon / Renovation COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLETE THIS SECTION & Complete items 1, 2, and 3. Aiso complete : _ item 4 if Restricted Delivery is desired. @ Print your name and address on the reverse : so that we can return the card to you. § Attach this card to the back of the mailpiece, or on the front if space permits. 1, Article Addressed to: Z00 70000ST » Adminis tater © Mea ltr Sovts Emerald (cast : Rehabilitation Haspt tat 1947 Flonds Awenve City, Flonde anama ») Panama © 3240S C. Dgte of Delivery Ue D Is delivery addi bss different If YES, enter delivery afd Certified Mail [© Express Mail OC Registered O Returm Receipt for Merchandise C1 insured Mail _ 11 C.0.D. 4. Restricted Delivery? (Extra Fee) 2. Article Number (Transfer from service lab 7006 2150 OOO4 5871 O7e81 ; PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1840 « UntTeD STATES PostatSERVIGE erye ROWE Ck x 3S OCT 2OIF Pel ah * Sender: Please print your name, address, and ZIP+4 in this box * Mary Daley Jacobs, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 BS4 TaolDoesiDedadosEDassesaHfeadl baabsbesdesbeeldfeaddsndldl

Docket for Case No: 07-005488