“STATE OF FLORIDA F / L f- 6D AGENCY FOR HEALTH CARE ADMINISTRATION OYS337 Mb OT 3 STATE OF FLORIDA, AGENCY FOR A DJ HEALTH CARE ADMINISTRATION, TR HEAR igyeal! VE Petitioner, vs. ; ~. Case No. 2007004950 CHERRY HOME HEALTH _ SERVICES, INC, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against Cherry Home Health Services, Inc (hereinafter Respondent), pursuant to Section . 400.932(3), Florida Statutes, (2006) and Section 408.815(1)(e), Florida Statutes (2006) , “and alleges: NATURE OF THE ACTION This is an action to revoke the Respondent's licensure as a home health agency. - JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat. (2006) and Chapter 59A-25, Florida Administrative Code. 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of home health agencies pursuant to Chapters 400, Part VI, and 408, Part II, Florida Statutes (2006), and. Chapter 59A-25, Florida Administrative Code. 4. Respondent is a facility located at 1671 ‘West 38 Place, #1408, Suite C, Hialeah, Florida, 33012, and was at all times material hereto a home health agency under Chapter 400, Part VU, Florida Statutes (2006) and Chapter 59A-25, Florida Administrative Code, having been issued license number 299992526, 5. Respondent was at all times material hereto licensed under the licensing authority of the Agency and was required to comply with all applicable rules and statutes. . COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. | 7. The Center for Medicare and Medicaid Services (“CMS”) is the unit of the United States Government that is responsible at the federal level for regulation of participation in the Medicaid and Medicare programs. 8. CMS has terminated the Respondent’s Medicare Provider Agreement and participation in the Medicare program. See Exhibit “A,” attached hereto and incorporated herein as if fully recited herein. The termination is a final decision of CMS not subject to further appeal by Respondent. 9. Florida law provides in relevant part: “License or application denial; revocation. (1) In addition to the grounds provided in authorizing statutes, grounds that may be used by the Agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: ... (e) The applicant, licensee, or controlling interest has been or is currently excluded, suspended, or terminated from participation in the State Medical Program, the Medicaid Program of any other state, or the Medicare Program.” Section 408.815, Florida Statutes (2006). 10. Florida law also provides in relevant part: (3) The agency may deny or revoke the license of any applicant that... 1 - (c) Has been or is currently excluded, suspended, or terminated from, or has voluntarily withdrawn from participation in Florida’s Medicaid program or any other state’s Medicaid program, or participation in the Medicare program or any other governmental or private health care or health insurance program.” Section 400.932(3)(c), Florida Statutes (2006). 11. That the Respondent’s termination from participation in the Medicare program constitutes grounds for the revocation of the Respondent’s license as a home health agency. WHEREFORE, the Agency intends to revoke Respondent’s license as a home health agency provider pursuant to Sections 400.953(3)(c) and 408.815(1), Florida Statutes (2006) Respectfully submitted-this 30 day of May , 2007, Q. (eS Grant P. Dearbom, Chief Facilities Counsel Fla. Bar. No. 0939961 Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 850.922.5873 (office) 850.921.0158 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. - All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308; Telephone (850) 922-5873. ' RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE ' J HEREBY CERTIFY that a true and correct copy of the foregoing has been: ©: served by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 4851: on ru la “4 3.0 , 2007, to 1671 West 38 Place, #1408, Suite C, Hialeah, Florida, 33012. , 7 ; fs Grant P. Dearborn, Chief Facilities Counsel Copies furnished to: Anne Memard, Unit Manager Licensed Home Health Programs Unit Department of Health & Human Services Centers for Medicare & Medicaid Services 6] Forsyth St, Suite. 4T20 Adlanta, Georgia 30303-8909 CENTERS for MEDICARE & MEDICAID SERVICES Apple ELH. Services.10-8197 Final Term itr. April 2, 2007 p 2 AS. ‘ . 1 oe : og to ae - Mgr. Jorge Pelaez, Administrator : : BS, 3; LN si Apple Home Health Services, Inc. , RED ~ % A 1671 West 38" Place 1408 Suite A : eA Ka, “a * ‘Hialeah, FL: 33012 4 . BPO ¢ Ga Co -“ “ * .. (CMS Certification Number: 10-8197 Dear Mr. Pelaez: . =" home health agency must meet all of the pertinent provisions of Section 1861 (0) of Title XVII o1 _ the Social Security Act and be in compliance with each of the Conditions of Participation (42 CFR 484.10-484.52) in order to participate in the Medicare/Medicaid programs. oO - The Florida Agency for Health Care Administration (AHCA) conducted a recertification survey at your facility on January 2, 2007. At that time, your facility was found not to be in compliance with the following Conditions of Participation: oo “484.18 Acceptance of Patients, Plan of Care, and Medical Supervision. . . 484.48 Clinical Records Following submission of an.acceptable plan of correction, the State Agency conducted revisits at your facility on February 1, 2007, and March 5, 2007. At both revisits, your facility was found not to be in compliance with the following Conditions of Participation: 484.18 Acceptance of Patients, Plan of Care, and Medical Supervision “ 484.48 Clinical Records A third and final revisit was conducted at Apple Home Health Services, Inc. on Mareh-29, 2007, and “Conitintied noncompliance at 484.18 and 484.48 was identified. Failure to correct the noncompliance with the Conditions of Participation has resulted in the termination of your provider agreement and participation in the Program (reference 42 CFR 489.53). ’ The Medicare Program will not make payment for home health services finished to patients whose plans of treatment are established after April 2, 2007. For patients whose plans of treatment are established before April 2, 2007, payment may be made for up to 30 days after the date of termination. . A listing of the names and health insurance claim numbers of beneficiaries served: by your home health agency on April 2, 2007, should be forwarded to your fiscal intermediary. . By copy of this letter, we are notifying the State Medicaid Agency of this termination action. g Pursuant to Federal regulations at 42 CFR 488. 456, we are required to notify they public of the termination date. Accordingly, a legal ad ran in the Miami Herald on March 24, 2007: ae : Termination scheduled for April 2, 2007. If you have any questions, please contact Elizabeth Jacobson at (404) 562-7428 or Colleen Sandmann at (404) 562-7458. Sincerely, Sandra M. Pace Associate Regional Administrator Division of Survey and Certification cc: Florida Agency for Health Care Administration (AHCA) » Florida Medicaid Agency Enclosures

Docket for Case No: 08-005327