STATE OF FLORIDA EDUARDO ERCIA, M.D., P.A., Petitioner, vs. AHCA NO. 2008000674 RENDITION NO.: AHCA-08- C5£O -S-OLC STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AVA 0002 Respondent. 7 / FINAL ORDER é ‘y “t me 0% Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated January 21, 2008, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 2) with the parties to these proceedings, and being well-advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated January 21, 2008, is superseded by the Settlement Agreement. 3. Upon the full execution of this Agreement, the Agency shall begin processing the Petitioner’s application for licensure. 4. The Petitioner waives service of a Notice of Intent to Impose a Late Renewal Fee, and shall pay, within thirty (30) days of the date of the rendition of this Order, a fee in the amount of fifty dollars ($50.00). 5. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this case number, should be sent directly to: Agency for Health Care Administration Office of Finance and Accounting Revenue Management and Accounting 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308. 6. Unpaid fees pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. 7. The Petitioner’s request for a formal administrative proceeding is hereby dismissed. 8. Each party shall bear its own costs and attorney’s fees. 9. The above-styled case is hereby closed. DONE and ORDERED this Pay of , 2008, in Tallahassee, Leon County, Florida. _jlehese Ka Z Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO 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 OF 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: Elizabeth Dudek Deputy Secretary Agency for Health Care Admin. 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 | (Interoffice Mail) Thomas M. Hoeler, Senior Attorney Office of the General Counsel Agency for Health Care Admin. 525 Mirror Lake Drive North, #330 St. Petersburg, Florida 33701 (Interoffice Mail) Jan Mills Agency for Health Care Admin. 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (interoffice Mail) A.S. (Gus) Weekley, Jr., M.D., Esquire Weekley, Schulte & Valdes, LLC, 101 East Kennedy Boulevard, # 2320 Tampa. Florida 33602-5179 (U.S. Mail) Office of Finance and Accounting Revenue Management and Acct. Agency for Health Care Admin. 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (interoffice Mail) The Hon. William F. Quattlebaum Division of Administrative Hearings The DeSoto Building 1230 Apacalchee Parkway Tallahassee, Florida 32399-3060 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the 77" day of Ahs 2008. >. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST ANDREW C. AGWUNOBI, M.D. sovennor SECRETARY . “Certified Article Number 7UbO 3901 9845 2887 6483 Eduardo Ercia M. D., PA S : Be RD = 6301 Memorial Highway, Suite 204 SENDERS RECO ' Tampa, Florida 33615 License/File Number: 800020773 Case #: 2008000674 Jan 21, 2008 NOTICE OF INTENT TO DEEM APPLICATION INCOMPLETE AND WITHDRAWN FROM FURTHER REVIEW : ; Your application for renewal is deemed incomplete and withdrawn from further consideration pursuant to Section 408.806(3)(b), Florida Statutes. Section 408.806(3)(b), F.S. contains the following language: Requested information omitted from _ an application for licensure, license renewal, or change of ownership, other than an inspection, must be filed with the agency within 21 days after the agency's request for omitted information or the application shall be deemed incomplete and shall be withdrawn from further consideration and the fees shall be forfeited. You were notified by correspondence dated July 17, 2007 to provide further information addressing identified apparent errors or omissions within twenty-one. days from the receipt of the Agency’s correspondence. Our records indicate you received this correspondence by certified mail on July 23, 2007. . As the following information was received within required timeframes but incomplete, your application is deemed incomplete and withdrawn from further consideration: Refer to enclosed copy of omission letter dated July 17, 2007. EXPLANATION OF RIGHTS Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your 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 you dispute. EXHIBIT 1 Visit AHCA online at http://ahca.myflorida.com 2727 Mahan Drive, MS# 32 Tallahassee, Florida 32308 SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. Agency for Health Caye Administration e By: Karen Rivera, Manager Laboratory Unit ce: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Eduardo Ercia, M.D., PA _CASE NO: 2008000674 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed Notice of Intent to Deem Incomplete and Withdraw from Further Review of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deem Incomplete and Withdraw from Further Review or some other notice of intended action by AHCA. An Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Deem Incomplete and Withdraw from Further Review or any other proposed action by AHCA. If an Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please reply using this Election of Rights form unless you, your attomey or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) Please return your ELECTION OF RIGHTS to: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: (850) 922-5873 ‘Fax: (850) 921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS: OPTION ONE (1) I admit to the allegations of facts and law contained in the Notice of Intent to Deem Incomplete and Withdraw from Further Review, or other notice of intended action by AHCA and I waive my right to object and have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the proposed penalty, fine or action. OPTION TWO (2) _ I admit to the allegations of facts contained in the Notice of Intent to Deem Incomplete and Withdraw from Further Review, or other proposed action by AHCA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3)______-I_ dispute the allegations of fact contained in the Notice of Intent to Deem Incomplete and Withdraw from Further Review or other proposed action by AHCA, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Subsection 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of receipt of this proposed administrative action, The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, which requires that it contain: 1. The name and address’ of each agency affected and each agency’s file or identification number, if known; 2. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any; _ 3. Anexplanation of how your substantial interests will be affected by the Agency’s proposed action; 4. A statement of when and how you réceived notice of the Agency’s proposed action; 5. A statement of all disputed issues of material fact. If there are none, you must state that there are none; 6. A concise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the Agency’s proposed action; 7. A statement of the specific rules or statutes you claim require reversal or modification of the Agency’s proposed action; and 8. A statement of the relief you are seeking, stating exactly what action you wish the Agency to take with respect to its proposed action. (Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.) License type: Clinical Laboratory License number: 2008000674 Licensee Name: Eduardo Ercia, M. D., PA Contact person: Name Title Address: Street and number City Zip Code Telephone No. Fax No. Email (optional) I hereby certify that Iam duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: ; Date: Print Name: Title: FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST , ANDREW C. AGWUNOBI, M.D. GOVERNOR : SECRETARY July 17, 2007 Certified Mail EDUARDO ERCIA EDUARDO ERCIA MD PA 6301 MEMORIAL HWY STE 204 TAMPA, FL 33615 ~ RE: license # 800020773 Dear Laboratory Services Provider: This letter is to acknowledge receipt of your application for your Clinical Laboratory. After review it was found to be incomplete. Applicants for licensure receive only one omission letter describing the corrections, omissions or revisions needed to deem the application complete. If the response to this omission letter does not satisfactorily address what is outlined below, the application will be denied. Therefore; pursuant to section 120.60(1), Florida Statutes, no further action can be taken until the following is received: Director Name: List the name and/or professional licensure number for the director on page 5 of a Complete and return the enclosed ''Declaration of Proposed Test Menu" form. This form is also available at http://ahca.myflorida.com/MCHQ/Health_ Facility Regulation/Laboratory Licensure/clini cal.shtml. The brand of test kit and/or instrument used-should be specified for each test listed. Complete and submit the Health Care Licensing Application, Health Care Licensing Application Addendum, and the Voluntary Board Member Affidavit available at this site: http://ahca.myflorida.com/MCHOQ/Corebill/index.shtml. If you do not have any voluntary - board members complete the Provider/Facility Information section at the top of the Voluntary Board Member Affidavit and put N/A at the bottom. Please be sure to include ownership information where applicable on the Health Care Licensing Application and the Health Care Licensing Application Addendum. FLORIDA 2727 Mahan Drive, MS#32 e. Visit AHCA online at Tallahassee, Florida 32308 COMPARE GARE i Health Care in the Sunshine http://ahca.myflorida.com P www.FloridaCompareCare.gov EDUARDO ERCIA MD PA Page2 July 17, 2007 Please send the required information, with a copy of this letter, no later than 21 days from the receipt of this letter to: Agency for Health Care Administration Laboratory Unit Mail Stop 32 2727 Mahan Drive Tallahassee, FL 32308 If the applicant fails to submit all the information required in the application within 21 days of this letter, the application will be denied and the fees shall be forfeited as required in subsection 408.806(3)(b), Florida Statutes. If you have any questions regarding this letter, please.contact me at (850)414-0340. Sincerely, . ; Ln VISHN April Scott, MLT (ASCP) Biological Scientist II Laboratory Licensure Unit a my UNITED STATES. POSTA: z Home | Help | Sign In Track & Confirm FAQs Track & Confirm Search Results Label/Receipt Number: 7160 3901 9845 2887 6983 cats Status: Delivered Track & Confirm f . . Enter Label/Receipt Number. Your-item was delivered at 11:24 AM on January 25, 2008 in TAMPA, FL 33615. - oo - an (Bs) { Additional Details > } ( Retuen to USPS.com Home > } a Notification Options ae —— ne - Track & Confirm by email Get current event information or updates for your item sent to you or others by email. { #o> ) ¥ Site Map. Contact Us Forms Gov't Services Jobs Privacy Policy Tens of Use National & Premier Accounts Copyright© 1999-2007 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA http://trkenfrm 1 .smi.usps.com/PTSInternet Web/InterLabelinquiry.do 01/28/2008 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EDUARDO ERCIA, MLD., P.A., DOAH No. 08-892 Petitioner, vs. AHCA No. 2008000674 STATE OF FLORIDA, AGENCY FOR HEALTH CARE AMINISTRATION, Respondent. / SETTLEMENT AGREEMENT The Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and the Petitioner, Eduardo Ercia, M.D., P.A. (hereinafter “the Petitioner”), pursuant to Subsection 120.57(4), Florida Statutes, each individually, a “party,” collectively “parties,” enter into this Settlement Agreement (hereinafter “Agreement”) and agree as follows: WHEREAS, the Petitioner is a clinical laboratory licensed pursuant to the provisions of Chapter 408, Part II, Florida Statutes, Chapter 483, Part I, Florida Statutes, and Chapter 59A-7, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the licensing and regulatory authority over the licensure of the Petitioner; and WHEREAS, the Agency served the Petitioner a Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated January 21, 2008, notifying the Petitioner of the Agency’s intent to withdraw its application for licensure from further review based upon the failure to timely provide information and/or documentation as required by law; and EXHIBIT Page 1 of 5 2 WHEREAS, the Petitioner has since provided the Agency the required information and/or documentation, WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the parties stipulate to the adequacy of considerations exchanged; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1, All recitals are true and correct and are expressly incorporated in this Agreement. 2. All parties agree that the “whereas” clauses incorporated in this Agreement are binding findings of the parties. 3. Upon full execution of this Agreement, the Petitioner agrees to waive any and all proceedings and appeals to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction; and further agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, that no agreement shall be deemed a waiver by either party of its right to the judicial enforcement of this Agreement. 4. Upon full execution of the Agreement, the parties agree to the following: a. The Notice of Intent to Deem Application Incomplete and Withdrawn From Further Review is superseded by this Agreement. a Page 2 of 5 b. Upon the full execution of this Agreement, the Agency shall begin processing the Petitioner’s application for licensure. c. Nothing in this Agreement shall prohibit the Agency from denying the application for licensure based upon any statutory and/or regulatory provision, including, but not limited to, the failure of the Petitioner to satisfactorily complete a survey reflecting compliance with al] statutory and rule provisions as required by law. d. The Petitioner waives the receipt of a Notice of Intent to Impose a Late Renewal Fee. e. The Petitioner shall remit to the Agency, within thirty (30) days of the entry of the Final Order adopting this Agreement, a late fee in the total sum of Fifty Dollars ($50.00). 5. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or its related Final Order shall lie solely in the Circuit Court of the State of Florida, in Leon County, Florida. 6. By executing this Agreement, the Petitioner admits the allegations raised in the Notice of Intent referenced above. 7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case(s). 8. Each party shall bear its own costs and attorney’s fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all parties. 10. The Petitioner acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the Page 3 of 5 Notice of Intent. This Agreement does not prohibit the Agency from taking action regarding the Petitioner’s Medicaid provider status, conditions, requirements or contract. 11. The Petitioner, for itself and any related or resulting organizations, successors or transferees, attorneys, heirs, and executors or administrators, discharges the Agency and its agents, representatives, and attorneys of all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of the Agreement, by or on behalf of the Petitioner or its related or resulting organizations. 12. This Agreement is binding upon all parties referenced in the Agreement and those identified in the aforementioned paragraph of the Agreement. 13. In the event that the Petitioner was a Medicaid provider at the subject time of the actions alleged in the Notice of Intent referenced above, this Agreement does not prevent the Agency from seeking any Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any federal issues that are or may be pending against the Petitioner. 14. The undersigned have read and understand this Agreement and have authority to bind their respective principals. The Petitioner’s representative has the legal capacity to execute this Agreement and has done so with the advice of its own independent counsel. The Petitioner understands that counsel for the Agency represents solely the Agency and that Agency counsel has not provided any legal advice to, or influenced, the Petitioner in the decision to enter into this Agreement. Page 4 of 5 a 15. | This Agreement contains the entire understandings and agreements of the parties. 16. This Agreement supersedes any prior oral or written agreements that may exist between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 17. All parties agree that a facsimile signature suffices for an original signature. 18. The following representatives acknowledge that they are duly authorized to enter into this Agreement. Aicttan Hig he 2 Lok Cree h. Elizabeth Dudek . Eduardo Ercia, M.D. Deputy Secretary Eduardo Ercia, M.D., P.A. Agency for Health Care Administration 6301 Memorial Highway, Suite 204 2727 Mahan Drive, Bldg. #1 Tampa, Florida 33615 Tallahassee, Florida 32308 patep: of #4 DATED: (Y~-/0-08 Tampa, Florida 33602-5179 Counsel for Petitioner DATED: it Aye Los 2727 Mahan Drive, Tallahassee, Florid j Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 DATED: Page 5 of 5

Docket for Case No: 08-000892