STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

FfLEO

/\HCA

AGENCY CLERK

zaoq JUL -1 P 12= 34

Petitioner,

vs.

IZZ and SONS, INC. d/b/a ROBERT'S DRUGSTORE,

Respondent.

CASE NO. 08-5835MPI Audit No.: CI 08-6792-000

Provider No.: 106388000

RENDITION NO.: AHCA-09- 5°21 -5-MDO

I

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

/' f­

day of - --,-,,+----' 2009, m

Tallahassee, Florida.

HOllYBENSON,SECRlTARY

Agency for Health Care Administration

1

Filed July 7, 2009 1:08 PM Division of Administrative Hearings.

A PARTY WHO IS 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 BYLAW, 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:

L. William Porter II, Esquire Agency for Health Care Administration

(Laserfiche)

William M. Furlow, Esquire

Metzger, Grossman, Furlow & Bayo, LLC 1408 N. Piedmont Way

Tallahassee, Florida 32308 (U.S. Mail)

Eleanor Hunter Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

Ken Yon, Bureau Chief, Medicaid Program Integrity Teva Anderson, Medicaid Program Integrity

Finance and Accounting

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 ay of_-...,.:_:_ :_::: , 2009.

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

STATE OF FLORIDA,

STATE OF PLOWA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FORHEALTH CARE ADMIN[STRATtON,

Petitioner,

vs.. CASE NO. og..s835MPI

C.I. 08-6792..000

IZZ AND SONS, INC. d/b/a ROBERT'S

DRUGSTORE,

Respondent.

------------------''

SETTLEMENT AGREEMENT

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

("AHCA" or "the Agency"), and Izz and Sons, Inc. d/bla Roberfs Drug Store ("PROVIDER"), by and through the undersi hereby stipulate and agree asfollows:

1. The two parties enter into this agreement to memorialize resolution of this matter.

1. PROVJDER is a Florida Medicaid provider, provider number 106388000 and was a provider during the audit period, January 1, 2005 to December 31, 2005.

2. In its Final Agency Audit Report (constituting fina1 agency action) dated August

1. 2008, AHCA notified PROVIDER that review of Medicaid claims by Medicaid Program Integrity {MPI). Office of the AHCA Inspector General, indicated certain claims1 in whole or in part. had been inappropriately paid. The Agency sought recoupment of this overpayment in the amo nt of $297,263.82. In response, PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No. 08-5835MPI.

   
   

   lzz and Sons► Inc. d/b/a Roberf s Drug Store Settlement Agreement

   1. Subsequent to the original audit, in preparation for trial, AHCA took depositions, conducted pre-trial discovery and re-reviewed the PROVIDER's claims. AHCA also evaluated additional documentation submitted by the PROVIDER. As a result of the additional review, AHCA determined the overpayment should be adjusted to $157,732.10.

   2. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA agree as follows:

      1. AHCA agrees to accept the payment set forth herein in full and final

         
         

         settlement of the overpayment issues arising from the captioned audit.

      2. Within thirty days of entry of tho final order, PROVIDER agrees to make a lump sum payment of fifty thousand dollars ($50,000.00) on this indebtedness. The balance of one hundred thirteen thousand two hundred thirty two dollars and ten cents ($113,232.10) plus five thousand five hundred dollars ($5.500) in fines

         ·for a total (including the initial lump sum payment) is one hundred sixty three thousand two hundred thirty-two dollars and ten cents ($163,232.10). The outstanding balance accrues at 100/4 interest per year. Payments of the balance

         $113,232.10 shall be made in twelve (12) equaJ monthly payments. This will then fully and completely settle all claims in these proceedings before the Division of Administrative Hearings (DOAH Case No. 08-5835MPI).

         -----------------------------------------···-·•-1---

         
         

         Izz and Sons, Inc. d/b/a Robert's Drug Store Settlement Agreement

      3. PROVIDER and AHCA agree that full payment, as set forth above, resolves and settles this case completely. It will release both parties :from any administrative or civil liabilities or claims arising from the :findings in audit C.I. 08-6792-000.

      4. PROVIDER agrees that it will not rebill the Medicaid. Program in any manner for claims that were determined not covered by Medicaid. which are the subject of the audit in this case.

   3. Payment shall be made to:

      AGENCY FOR HEALTHCARE ADMINISTRATION

      Medicaid Accounts Receivable Post Office Box 13749 Tallahassee. Florida 32317-3749

   4. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute PROVIDER'S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to PROVIDER for any Medicaid cJaims.

   5. AHCA reserves the right to enforce this Agreement-under the laws of the State of F'lol'ida, the Rules of the Medicaid Program. and all other applicable rules and regulations,

   6. PRQVIDER acknowledges their obligation to adhere to state and federal

      
      

      Medicaid laws, ntles, provisions, handbooks and policies.

      
      

   7. Izz and Sons, Inc. d/b/a Robert's Drug Store> a Medicaid provider operating under provider number 10638800-0, J1ereby acknowledges their obligation to adhere to state and federal Medicaid laws, rules, provisions, Handbooks, and policies. Additionally, Izz and Sons, Inc. d/b/a Robert's Drug Store acknowledges that Medicaid policy requires providers to follow the guidelines set forth in the applicable Rules, Handbooks and Medicaid fee schedules, as

      
      

      Izz and Sons, Inc. d/b/a Robert's Drug Store SetUement Agreement

      promulgated in the Medicaid policy Handbooks. billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these promulgated guidelines.

   8. 'Ibis settlement does npt constitute an admission of wrongdoing or error by either party with respect to this case or any other matter.

   9. Each party shall bear its own attorneys• fees and costs, if any.

      
      

   10. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties.

   11. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Circuit Court, Leon County. Florida.

   12. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements betwee11 PROVIDER and the AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties.

   13. This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect widerstandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law. so that no misunderstanding or misinformation shall be a ground for rescission hereof.

       
       

       lzz and Sons. Inc. d/b/a Robert's Drug Store Settlement Agreement

   14. PROVIDER expressly waives in this matter its right to any bearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making offmdings of fact and conclusions of law by the Agency, and an further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceedin& circuit or federal court action or any appeal.

   15. This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it.

   16. To 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.

   17. This Agreement shall inure to the benefit of and he binding on each party's successors, assigns, heirs. administrators, representatives and trustees.

   18. All times stated herein are of the essence of this Agreement.

   19. This Agreement shall be in full force and effect upon execution by the respective

. parties in counterpart.

4'1L

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IZZ AND SONS, INC. D/B/A ROBERrs DRUG STORE

Dared,

A

BY: (P !, o.{\ (2.,

ITS: V-Ptf4.

,2009

lzz and Sons, Inc. d/b/a Robert's Drug Store Settlement Agreement

AGENCY FOR HEALTH CARE ADMINISTRATION

2727 Mahan Drive, Mail Stop #3

Tallahassee, FL 32308-5403

Peter Williams

Inspector General

General Counsel.

Dated: i .2009

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Dated: s/4p .2009

L. William Porter 11

Assistant General Counsel

llmt :,.&,

.2009

Docket for Case No: 08-005835MPI

Orders for Case No: 08-005835MPI