Apr 22 2009 11:38 APR-22-2089 12:58 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@1-a9 Agency for Health Care Administration Office of the General Counsel To: Clerk of Court Company: Phone: Fax: From: Lindsey Beck, OPS Senior Clerk Company: Agency for Health Care Administration Office of the General Counsel Phone: (850)410-6025 Fax: (850)921-0158 Date: 4/21/2009 Pages including this cover page: 9 Comments: DOAH No. 08-4578 AHCA No. Ci 08-7332-000 Final Order for SCG Laurellwood, LLC d/b/a Laurellwood Nursing Center Apr 22 2009 11:38 APR-22-2089 12:51 AGENCY HEALTH CARE ADMIN 854 921 8158 = P.a2va9 PILED ANCA STATE OF FLORIDA AGENCY CLERK DIVISION OF ADMINISTRATIVE HEARINGS 2M APR 22 AW 17 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VS. CASE NO. 08-4578MPI PROVIDER NO.: 031662800 C.LNO,; 08-7332-000 SCG LAURELLWOOD, LLC dib/a RENDITION NO.: AHCA-09- 2.34 -S-MDO LAURELLWOOD NURSING CENTER, Respondent. { pu FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the Qo? day of Ap] , 2009, in Tallahassee, Florida. HOLLY BENSON, SECRETARY Agency for Health Care Administration Apr 22 2009 11:38 APR-22-2089 12tot AGENCY HEALTH CARE ADMIN 856 921 4158 A PARTY WHO JS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A 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 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: Daniel M. Lake, Esquire Agency for Health Care Administration (Interoffice Mail) Jonathan §. Grout, Esquire Goldsmith & Grout, P.A. 2160 Park Avenue North Winter Park, Florida 32789 (U.S. Mail) William F. Quattlebaum Administralive Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Ken Yon, Chief, Medicaid Program Integrity Lawrence E. Stivers, Medicaid Program Integrity Finance and Accounting P.@3/89 Apr 22 2009 11:38 APR-22-2089 12tot AGENCY HEALTH CARE ADMIN 856 921 4158 P.@4/89 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the Zz day of Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration . 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 Apr 22 2009 11:39 APR-22-2609 12:54 AGENCY HEALTH CARE ADMIN 856 921 8158 P6589 Dec. 2. 2008 3:14PM Goldsmith, Grout & Lewis Noo2Z! ot. 3 Dec, TR 2008 9:50AM Goldsmith, Grout & Lewis No 5204 BL 2 STATE OF FLORIDA Q DIVISION OF ADMINISTRATIVE HEARINGS CE LAURELLWOOD, LLC d/b/a LAURELL WOOD NURSING CENTER, Petitlonay, Case Nov 68-4578 PFT Vk . * Pyovider No 0316628000 CA, No.2 08-7332-000 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY POR HEALTH CARE ADMINISTRATION ("AHCA” ox “tho Agency”), and sce Latirellwood, LLC d/b/a Lauellwood Nursing Centet. . PROVIDER’), by and through the undersigned, hereby stipulate and agree as follows: 1, The parties enter into this agreement for thé purpose of memorializing the resolotion to thig matter, 2, Laurellwood Nursing Center is a Medicaid provider in the State of Florida, provider mumbet 0316628000 and was a provider duing the audit periad, 3. Th its Finsl Agency Audit Report dated August 18, 2008, AHCA notified LAURRLLWOOD NURSING CENTER that review of Medicaid claims performed .by the Offics of Medicaid Progvam Tntegrity (MPD, of the ANCA Inspecior General, indicated that certain claims, in whole ot in part, ware inappropriately paid by Mediceid. The Agency sought repayment of this overpayment, in the amount of $157,040.80. Tn response to the audit report dated Angust 18, 2008, Petitioner sent a letter to the Agency requesting an Administrative Hearing. Apr 22 2009 11:39 APR-22-20@9 12:52 AGENCY HEALTH CARE ADMIN 958 921 g158 P.ae-a9 Dec. 22 2008 3:14PM «Goldsmith, Grout & Lewis No 5221 FR 4 Dec, 18. 2008 9:50AM Goldsmith, Grout & Lewis No, 5204 =P. 3 Laureliwood Nursing Center Settlement Agreement 4, LAURELLWOOD NURSING CENTER, and the AHCA expressly agvee as follows: In order to sesolve this matter without further administrative proceedings, (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues artaing from the MPI veview. (2) — Within thirty (20) days of the dats of excontion of a Final Order adopting this Settlement Agreement, LAURELLWOOD NURSING CENTER figress to taka ons ump sum payment of five hundred dollars ($500,00) for an. administrative fine. The above lunp sum payment will constitute full and complete seitlerent of all claims in the proceedings of C.J, No. 08-7332-000. (3) LAURELLWOOD NURSING CENTER and AHIGA agree that such payment as get forth above will resolve and settle this case completaly ancl release both parties from all liabilities arising ftom the findings in the audit referenced as C.1. No. 08-7332-000, (4, LAURELLWOOD NURSING CENTER acknowledges their obligation to adhaye to state and federal Medicald laws, rules, provisions, handbooks and policies, the goidelines set forth in the applicable rules and Madicaid fee schedules, as promulgated in the Medicaid poltey handbooks, billing bulleting, and the Medicaid provider agreement, and agrees that Medicaid dots not pay for services that do nat meet these guidelines, Paymont shall be made to; AGENCY FOR HRALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 . Talighaases, Florida 32317-3749 Apr 22 2009 11:39 APR-22-28H9 12:52 AGENCY HEALTH CARE ADMIN Soa 924 Dee 02, 2008 3:14PM Goldsmith, Grout & Lewis Woden ae Dec. 19. 2008 9:50AM Goldsmith, Grout & Lewis No 5204 PL 4 Laurellwood Nuvsing Center Settlement Agreement § LAURELLWOOD NURSING CENTER agrees that failure to pay any monies due and owing under the terms of this Agreement ehall constitute PROVIDER?S authorization for the Agency, without further notice, to withhold the total remaining amount dus under the tetms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 7 ARICA veserves the right to enforce this Agreentant under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable roles atd régulations. & Thia settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other mafter, ° ) 9. The signatories to this Agreement, acting in a representative capacity, represent that they ave duly authorized to enter into this Agreoment on behalf of the respective parties. 10, This Agreement shall be cofistined in acoordanse with the provisions of the lawa of Blovida, Venus for any action arising fiom this Agreement shall be in Leon County, Florida. 11. , This Agreement constitu the entire agreement between LAURELLWOOD NURSING CENTER and ANCA, including anyone acting for, associated with or einployed by them, concerning all matters and supersedes any prior digoussions, agreements or understandings; there are no promises, represehtations or agreements, between LAURELLWOOD NURSING CENTER and AHCA other than as set forth herein. No niodification or waiver of any provision shall be valid woless a weltten arsendment to the Agreement is completed and properly executed by the parties. 12. Thig is an Agreement of Settlement and Compromise, made in recognition that the patties may have different or incorrect understandings, information and contentions, as to facts ahd lav, and with each patty compromising aud settling any’ potential correctness or Apr 22 2009 11:40 APR-22-2089 12:52 AGENCY HEALTH CARE ADMIN 950 921 GiSe = P.aa-ne Dee. 22. 2008 3:14PM Goldsmith, Grout & Lewis No.b2Zl of Dec, 18. 2008 9:50AM Goldsmith, Grout & Lewis Ho. 5204 PL 5 ~ Laureliwood Nuseing Centor Settlement Agraement incomeotness of its understandings, information and contentions as to facts and law, so that no misunderstanding ot misinformation shall be a ground for rescission hereof. 13. LAURELLWOOD NURSING CENTER expressly waives in this matter lta right to any heaving pursuant to sections 120,569 or 120.57, Plovida Statutes, the making of findings of faot and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by Jaw or rules of the Agency regarding this proceeding and any and all issues raised herein, LAURELLWOOD NURSING CENTER further agrees that it shall not challenge or contest any Final Order entered in this matter which ig consistent with the terms of this settlement agreement in. any forum now or in the future available to it, inchading the right te any administvative proceeding, clrenit or federal court action or any appeal, 14. This Agreament is and shell be decmed jointly drafted and wuitien by all parties to it and shall not be construed or interpreted against the party oviginating or preparing it, 1s, ty ‘o the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement, 16. This Agroament shall inure to the benefit of and be binding on each party's successors, assigns, bois, administrators, representatives and trustees. 17. All times stated herein are of the eseence of this Agreement, 18. This Agreement ahall be in full foves and effect upon execution by the respective parties in counterpart, Apr 22 2009 11:40 APR-22-209 12:53 AGENCY HEALTH CARE ADMIN Dec. 22, 2008 3:14PM Goldsmith, Grout & Lewis ee Bet Bis P.BS"S Dec, 18. 2008 9:50AM Goldsmith, Grout & Lewis No. 5204 =P 6 Laurellwood Nursing Center “Settlement Agreement LAURELLWOOD NURSING CENTER i a A Dated: l \2¢ by bu. [8 , 2008 BY: he (Print name) Sp vier Qenuiy ne benp LINEA iy bed AGENCY FOR HEALTH CARL ADMINISTRATION 272.7 Mahan Delve, Bldg. 3, Mail Stop #3 Tallahassee, PL 32308-5404 & rhs Dated: Agern| As. soy! Peter H, Willlams Inspector Genexal 7 Dated: ford, LE : 200 Dated: , 2007 ge ve wok e (buyer Dated: 3 } LS i , 20097 “Kim Rellum Chie? Medioald Coungel TOTAL FP.@o

Docket for Case No: 08-004578MPI