STATE OF.FLOR AGENCY FOR HEALTH CA ORIOL srearroh” oe PEL IES 2008 JUN ke 003 SHAT ATE 00 STB PRIMARY CARE PHYSICIANS — ALLIANCE, LLC., 2 " FA Ria Petitioner, REAKSCASe NO.: 08-1945 FRAES NO.: 2008003477 vs. RENDITION NO.: AHCA-08-(5(.¢(¢-S-OLC 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 / FINAL ORDER Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated March 18, 2008, attached hereto and incorporated herein (Ex. 1), and ali other matters of record, the Agency for Health Care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 The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated March 18, 2008 is deemed superseded. 3. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner’s application. 4. Each party shall bear its own costs and attorney’s fees. 5. The above-styled case is hereby closed. DONE and ORDERED this _// day of Pierre , 2008, in Tallahassee, Leon County, Florida. Holly Bens Agency _f n, Secretary 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 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 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 _| Cinteroffice Mail) [Jan Mills Charles R. Fletcher and Agency for Health Care Admin. Erin Smith Aebel 2727 Mahan Drive, Bidg #3, MS #3 101 East Kennedy Blvd., Ste. 2800 Tallahassee, Florida 32308 Tampa, Florida 33609 (Interoffice Mail) (U.S. Mail) : i Carolyn S. Holifield, Administrative Law Judge Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway 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 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 HOLLY BENSON GOVERNOR SECRETARY March 18, 2008 CERTIFIED MAIL #7160 3901 9845 4790 4858 NORMAN J CASTELLANO MD ; ; PRIMARY CARE PHYSICIANS ALLIANCE LICENSE NUMBER: 800002605 2727 W MLKING JR BLVD SUITE 450 TAMPA, FL 33607 CASF #: 2009903477 NOTICE OF INTENT TO DEEM APPLICATIC™ iN N_FROM FURTHER REVIEW Your application for Clinical Laboratory Licensure 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 December 18, 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 December 28, 2007. As the following information was not received, your application is deemed incomplete and withdrawn from further consideration: Refer to enclosed copy of omission letter dated December 18, 2008. EX) TIO HTS 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 hitp://ahea, mytlorida.com 2727 Mahan Drive,MS#32 Tallahassee, Florida 32308 EXHIBIT “A” PAGE 1 OF 6 Primary Care Physicians Aluance Page 2 March 18, 2008 SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. Agency for Health Care Administration wo &. bh ov By: Karen Rivera, Manager Laboratory Unit ce: Agency Clerk, Mai! Stop 3 Legal Intake Unit, Mail Stop 3 EXHIBIT “A” PAGE 2 OF 6 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: PRIMARY CARE PHYSICIANS ALLIANCE CASE NO: 2008003477 ECTION 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. Election of Rights must be returned by mai fax withi: s of the da: ceive 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 | 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. 1 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, EXHIBIT “A” PAGE 3 OF 6 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 bearing. 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, arid telephone number of your representative or lawyer, if any; 3. An explanation 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: clinica) laboratory License number: 800002605 Licensee Name: PRIMARY CARE PHYSICIANS ALLIANCE Contact person: Name Title Address: Street and number City Zip Code Telephone No. Fax No. Email (optional). Thereby certify that ] 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: ate: Print Name: Title: EXHIBIT “A” PAGE 4 OF 6 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CAIST ANDREW C. AGWUNOBI, M.D. GOVERNOR . ; SECRETARY December 18, 2007 . Certified Mail NORMAN J CASTELLANO MD PRIMARY CARE PHYSICIANS ALLIANCE act 2727 W MLKING JR BLVD SUITE 450 TAMPA, FL 33607 ereg 380) SA45 2883 ¥SS3 ECORD Dear Clinica! Laboratory Applicant: SENDERS R 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 deemed incomplete and withdrawn from further consideration. Therefore, pursuant to section 120.60(1), Florida Statutes, no further action can be taken until the following is received: 1. 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, a copy of the most recent annual report, or a copy of the Articles of Incorporation. (2) Submit proof of Level 2 Background Screening for the laboratory director and chief financial officer. If the laboratory director ig a physician who has been A fingerprinted for renewal of his/her medical license, send proof documenting this WN and include a copy of his/her current medical license. If fingerprints have not been submitted for Level 2 background screening within the past 5 years, use the i enclosed fingerprint card(s) and submit one per person screened, with a check to AHCA for $42.25 per person screened. 3. Tax ID: Federal Tax ID number was not indicated on page 2, Submit a copy of your W.9. 4. Please submit a copy of your most recent accreditation organization survey. Complete and submit Affidavit for Compliance with Background Screening Requirements for the laboratory director and chief financial officer, available at this iw 2 Tallahasses, Florida 32308 Manan Drive, MS#32 Visit AHCA online at Hitpi//ahca.myflorida.com EXHIBIT “A” PAGE 5 OF 6 Usros- lrack & Conlim buggy a vee UNITED STATES POSTAL SERVICES Home | Help | Signin Track & Confirm Search Results Label/Receipt Number: 7160 3901 9845 4790 4858 Status: Delivered Enter Label/Receipt Number. Your item was delivered at 2:14 PM on March 24, 2008 in TAMPA, FL 33607 Ga? Notification Options Track & Confirm by email . Get current event information or updates for your item sent to you or others by email. (Ba>3 Site Map. Contact Us Forms Gov't Services. Jobs. Privacy Policy Terms of Use. National & Premier Accounts pam Copyright® 1999-2007 USPS. All Rights Reserved. © No FEAR Act EEO Data FOIA @ a“ http://trkcnfrm 1 .smi.usps.com/PTSInternet W eb/InterLabelInquiry.do 04/15/2008 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PRIMARY CARE PHYSICIANS ALLIANCE, LLC, Petitioner, Case Nos.: 08-1945 vs. 2008003477 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Primary Care Physicians Alliance, LLC (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, Petitioner has requested a formal hearing by filing a petition and selecting Option “3” on the Election of Rights Form; and EXHIBIT SA NOI Dismiss 2 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 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 Notice of Intent to Deem Application Incomplete and Withdrawn From Further Review is deemed superseded. b. Upon the full execution of this Agreement, the Agency shall finalize the processing of Petitioner’s application. c. 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. HQA, Dephity Secretary Agenc Health Care Administration 2727 Mahan Drive, Bldg #1 Tallahassee, Florida 32308 DATED: G/l/ [300 “