STATE OF FLORIDA -AGENCY FOR HEALTH CARE ADMINISTRATION 4&: 780 gt UL A FAY 2 SIGNAL MUTUAL INDEMNITY OPYISION CF ASSOCIATION, LTD., and ADMINISTRATIVE INTEGRA GROUP, INC., HEARINGS Petitioners, DOAH CASE NO. 08-1993 : : AHCA NO. 2008004807 v. DETERMINATION NO. 20071210-003 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioners filed on April 14, 2008. On April 18, 2008, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On April 23, 2008, the Petitioners and Respondent filed a Joint Settlement Stipulation and Agreed Motion to Relinquish Jurisdiction, stating that AHCA lacks jurisdiction over the reimbursement dispute. On May 1, 2008, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioners’ Petition is dismissed, because the injured employee was subject to the Longshore and Harbor Workers’ Compensation Act. Shands Jacksonville should seek remedy for determination of disputed reimbursement from the U.S. Department of Labor, Employment Standards Administration, Office of Workers’ Compensation Programs, Department of Longshore and Harbor Workers’ Compensation Act, 400 West Bay Street, Jacksonville, Florida 32202. This matter is hereby closed. The parties shall govern themselves accordingly. DONE and ORDERED this 27 ker of Gee , 2008, in Tallahassee, are BENSON, ae? ‘ ¢ yj AGENCY FOR HEALTH CARE ADMINISTRATION Florida. NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE PRESCRIBED BY LAW WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE - ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE — I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been oi furnished by U.S. or interoffice mail to the persons named below on this vO day of ere _, 2008. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Honorable Barbara J. Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 James W. McCready, IIT, Esquire Seipp & Flick, LLP Two Alhambra Plaza, Suite 800 Miami, Florida 33134 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Shands Jacksonville c/o Keisha McBride Post Office Box 862385 Orlando, Florida 32886-3285 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance

Docket for Case No: 08-001993