STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ERK SMH PHYSICIAN SERVICES, INC., 1G AUE Le A @53 d/b/a ASSOCIATES IN INTERNAL ~~ MEDICINE, FRAES NO.: 08-1104 Petitioner, CASE NO.: 2008003578“, RENDITION NO.: AHCA-08- o 144, -S- Oe ae a vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated February 10, 2008, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care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 otherwise 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 Petitioner shall pay, within thirty (30) days of the date of rendition of this Order, a late renewal fee in the amount of fifty dollars ($50.00). 3. 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. 4. Unpaid fines pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. 5. The Petitioner’s petition for a formal administrative proceeding is hereby dismissed. 6. Each party shall bear its own costs and attorney’s fees. 7. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner's application. 8. The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated February 10, 2008, as to the Petitioner’s renewal application, is deemed superseded. 9. The above-styled case is hereby closed. DONE and ORDERED this bay of ee eas , 2008, in Tallahassee, Leon County, Florida. Mikeewe Aiea Holly Benson, Secretary 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 QTHE 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 Amie C. Ragano, Senior Attorney Deputy Secretary Agency for Health Care Admin. Agency for Health Care Admin. Office of the General Counsel 2727 Mahan Drive, Bldg #1, MS #9 Sebring Building, Suite 330L Tallahassee, Florida 32308 525 Mirror Lake Drive North (Interoffice Mail) St. Petersburg, Florida 33701 Interoffice Mail) Jan Mills Radha V. Bachman, Esq. Agency for Health Care Admin. Attorney for Petitioner 2727 Mahan Drive, Bldg #3, MS #3 200 South Orange Avenue Tallahassee, Florida 32308 Sarasota, Florida 34236 (interoffice Mail) (U.S. Mail) Agency for Health Care Admin. William F. Quattlebaum, Office of Finance and Accounting Administrative Law Judge Revenue Management and Acct. Division of Administrative Hearings 2727 Mahan Drive, MS #14 ‘| The DeSoto Building Tallahassee, Florida 32308 1230 Apalachee Parkway (Interoffice Mail) Tallahassee, Florida 32399-3060 (U.S. 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 /&” day of agus OC , 2008. (SS Richard Shoop, Agency Clerk Agency for Health Care Administration ' 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 ZOOS CCI TS FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST : ANDREW C. AGWUNOBI, M.D. GOVERNOR SECRETARY : . ENTE S “February 10, 2008 Associates in Internal Medicine 1921 Waldemere Street, Suite 605 Sarasota; Florida 34239-2913 ; License/Fil ile Number: 800004720 Case #: 2008001678 NOTICE OF INTENT T0 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 August 22, 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 August 24, . 2007. As the following information was recevied within required timeframes but incomplete, your application i is deemed incomplete and withdrawn from further consideration: Refer to enclosed copy of omission letter dated August 22, 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 el Visit AHCA online at 2727 Mahan Drive, MS# 32 http://ahca.myflorida.com Tallahassee, Florida 32308 SEE: ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. Agency for HealthCare Administration By: Karen Rivera, Manager Laboratory Unit ; cc: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 ORD: FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, : ANDREW C. AGWUNOBI,-M.D. “CHARLIE CRIST SECRETARY GOVERNOR August 22, 2007 Certified Mail — ROBERT L OPPENHEIMER MD ASSOCIATES IN INTERNAL MEDICINE 1921 WALDEMERE STREET SUITE 605 SARASOTA, FL 34239 ~ RE: license # 800004720 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: ; Cert of Status: Submit a copy of the corporation's Certificate of Status issued by the Florida Department of State (850-488-9000). In lieu of a Certificate of Status, you may — submit a copy of the corporation information available on www.sunbiz.org (Online Searches, Corporations, Name Inquiry, then print Public Inquiry page), a copy of the most recent annual report, or a copy of the Articles of Incorporation. This is requested due to a discrepancy between the owner name and Tax JD number submitted on the application and the owner name and Tax ID number we have in our system. If you have encountered a change in ownership a copy of the Bill of Sale or other equivalent closing documents will also need to be submitted. If you have not encountered a change in ownership a typed . letter on letterhead clarifying this discrepancy will need to be submitted with the Cert of Status. Complete and return the enclosed Health Care Licensing Application. This form is also available at this site: http://ahca.myflorida.com/MCHQ/Corebill/index.shtml. Be sure to include ownership information where applicable. PrFLORIDA — Visit AHCA online at 2727 Mahan Drive, MS#32 i DOMPARE CARE Tallahassee, Ftorida 32308 ee G Moat http://anca.myflorida.com Health Care in the Sunshine ASSOCIATES IN INTERNAL MEDICINE Page 2 August 22, 2007 Complete and return the enclosed Voluntary Board Member Affidavit. This form is also available at: http://ahca.myflorida.com/MCH¢ )/CorebilVindex.shtml. The Voluntary Board Member Affidavits were submitted incomplete. 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, : , April Scott, MLT (ASCP) Biological Scientist IJ Laboratory Licensure Unit ew eve 2aeverae ar reoun. . STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Associates in Internal Medicine CASE NO: 2008001678 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 Jaw 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. | 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. eee erevievyy ative. ae om ro vw ae See ee OPTION THREE (3) A I dispuie the allegations of fact contained in the Notice of Intent to Deem Incomplete and Withdraw from Further Review or other proposed action 1 by AHCA, and J 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 received 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: 800004720 Licensee Name: Licensee Name Contact person: . Name Title Address: 200 $_Qnange. Ave. _Seamntsobi FL ___3123%9—___—_— Street and number City Zip Code (cD) ay Telephone No. 329-643 Fax No.$62-7235 __ Email (optional) I hereby certify that 1 am 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: 2-25°, Print Name: Rand BACHMAN Title: Caungse\ — ____ uors - 1rack & Connirm Buy a eee Ba er ev Home } Hem | $ionin Track & Confirm Search Results Label/Receipt Number: 7160 3901 9845 4793 6774 ao Status: Delivered Track & Confirm Enter Label/Receipt Number. Your item was delivered at 11:52 AM on February 13, 2008 in SARASOTA, FL 34239. € Avditional Details> 3 CRetura to USPS.com Home> } ‘Notification Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email . Site Map Contact Us Eorms Gov't Services Jobs Privacy Policy Terms of Use National & Premier Accounts Copyright© 1999-2007 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA http://trkcnfrm 1 smi.usps.com/PTSInternet Web/InterLabelInquiry.do 02/14/2008 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION SMH PHYSICIAN SERVICES, INC. d/b/a ASSOCIATES IN INTERNAL MEDICINE, Petitioner, Case Nos.: 08-1104 © vs. 2008001678 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “A gency”), through its undersigned representatives, and Petitioner, SMH PHYSICIAN SERVICES, INC. d/b/a ASSOCIATES IN INTERNAL MEDICINE (hereinafter “Petitioner”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Petitioner is an applicant for clinical laboratory licensure pursuant to Chapters 408, Part II and 483, Part I, Florida Statutes and Chapter 59A-7, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure sought by Petitioner; and WHEREAS, the Agency served the Petitioner with a Notice of Intent to Deem Application Incomplete and Withdrawn From Further Review notifying the party of its intent to deny Petitioner’s application for licensure; and 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 EXHIBIT SA NOI Dismiss 2 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 herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. | 3. Upon full execution of this Agreement, Petitioner agrees to a withdrawal of any request for an administrative proceeding; 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), a formal proceeding under Subsection 120.57(1), 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 herein, shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. 4. Upon full execution of this Agreement, the parties agree to the following: a. The Petitioner shall remit to the Agency, within thirty (30) days of the entry of a Final Order adopting this Agreement, a late renewal fee in the sum of Fifty Dollars ($50.00). b. The Petitioner waives receipt of the Notice of Intent to Impose a Late Renewal Fee. c. The Notice of Intent to Deem Application Incomplete and Withdrawn From Further Review is deemed superseded. d. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner’s application. €. Nothing in this Agreement shall prohibit the Agency from denying Petitioner’s _ application for licensure based upon any statutory and/or regulatory provision, including, but not limited to, the failure of Petitioner to satisfactorily complete a survey reflecting compliance with all statutory and rule provisions as required by law. 5. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 6. 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). 7. Each party shall bear its own costs and attorney’s fees. 8. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 9. The Petitioner for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge 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 this Agreement, by or on behalf of the Petitioner or related or resulting organizations. 10. . This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph of this Agreement. 11. In the event that Petitioner is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. 12. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 13. This Agreement contains the entire understandings and agreements of the parties. 14. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be amended except in writing. Agreement shall-be void. 15. All parties agree that a facsimile signature suffices for an original signature. 16. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. ns Dudek / “4 Z HQA, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bidg #1 Tallahassee, Florida 32308 DATED: Vier Craig H¢S , General Counsel Florida Bar No. 96598 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: _§ -(2-0¢ Radha V. Bachman, Esq. Florida Bar No.: 0018524 200 South Orange Avenue Sarasota, Florida 34236 Attorney for Petitioner DATED: ‘F76-0¥ | ie C. Ragano, Senior Attorney Florida Bar No.: 45632 Agency for Health Care Administration 525 Mirror Lake Drive, North, Suite 330 | St. Petersburg, Florida 33701 DATED: eo; z { | Os Any attempted assignment of this

Docket for Case No: 08-001104