STATE OF FLORIDA

, , ,. ;\i_/;:\ ,

AGENCY FOR HEALTH CARE ADMI NI STRATI ON.

1.:-

" "' 1 -:...: ,: ,.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

ZOii OCT - L1 A 8: 4 8

vs.

Petitioner,

DOAH CASE NO.: 09-1383

AHCA CASE NO.: 2008013528 CON NO. 7904

RENDITION NO. : AHCA-11- Jo£ -S-OLC

LIFE CARE HEALTH RESOURCES, INC., d/b/a LIFE CARE CENTER OF SARASOTA,

Respondent. /

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

CLAY COUNTY MEDICAL INVESTORS, LLC, d/b/a LIFE CARE CENTER OF ORANGE PARK,

Respondent. /

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH CASE NO.: 09-2074 AHCA CASE NO.: 2009000372 CON NO. 8813

NEW PORT RICHEY MEDICAL INVESTORS, LLC, d/b/a LIFE CARE CENTER OF NEW PORT RICHEY,

Respondent. /

Filed October 4, 2011 3:36 PM Division of Administrative Hearings

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH CASE NO.: 09-2076 AHCA CASE NO.: 2009000369 CON NO. 8975

LIFE CARE CENTERS OF AMERICA, INC., d/b/a LIFE CARE CENTER OF PORT ST. LUCIE,

Respondent. /

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH CASE NO.: 09-2077 AHCA CASE NO.: 2009000371 CON NO. 7923

LIFE CARE CENTERS OF AMERICA, INC., d/b/a LIFE CARE CENTER OF OCALA,

Respondent. /

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH CASE NO.: 10-5421 AHCA CASE NO.: 2008013532 CON NO. 3828

MELWOOD NURSING CENTER, LLC, d/b/a LIFE CARE CENTER OF MELBOURNE,

Respondent. /

FINAL ORDER

THIS CAUSE comes before the AGENCY FOR HEALTH CARE ADMINISTRATION (the "Agency") concerning the Administrative Complaints for LIFE CARE CENTER OF SARASOTA, CON 7904, LIFE CARE CENTER OF ORANGE PARK, CON 7737, LIFE CARE CENTER OF NEW PORT RICHEY, CON 8813, LIFE CARE CENTER OF PORT ST. LUCIE, CON 8975, LIFE CARE CENTER OF OCALA, CON 7923 AND LIFE CARE CENTER OF MELBOURNE,

CON 3828 collectively known as Life Care Centers of America (hereinafter "Life Care") which the Agency filed the Administrative Complaints for Life Care's failure to comply with Medicaid conditions placed on the CONs. Composite Exhibit 1. The parties have since entered into a Settlement Agreement. Exhibit 2.

It is ORDERED that:

1. The findings of fact and conclusions of law set forth in the Administrative Complaint are adopted and incorporated by reference into this Final Order.

2. The Settlement Agreement is attached hereto and made a part hereof. The parties are directed to comply with the terms of the Settlement Agreement upon payment of any fines.

3. The Respondent shall pay the Agency a total of $5,780.00 within 30 days of the date of this Final Order. The total amount is divided among the cases as such:

   
   

   Case Number	2008013528	-	$323.00
   Case Number	2008013522	-	$663.00
   Case Number	2009000372	-	$1,663.00
   Case Number	2009000369	-	$1,530.00

   Case Number 2009000371 - $1,365.00 Case Number 2008013532 - $236.00

   
   

4. A check made payable to the "Agency for Health Care Administration" and containing the AHCA ten-digit case numbers should be sent to:

   Office of Finance and Accounting Revenue Management Unit

   Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 14

   Tallahassee, Florida 32308

   
   

5. The above-styled cases are hereby closed.

DONE AND ORDERED this Z--1 day of 011, in Tallahassee, Florida.

Elizab

Agen tion

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 furnished by U.S. or interoffice mail to the persons named below on this '/,:r: day of

RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

(850) 412-3630

COPIES FURNISHED TO:

Charles A. Stampelos Administrative Law Judge

Division of Administrative Hearings (Electronic Mail)

Jay Adams, Esquire Broad and Cassel

215 South Monroe Street, Suite 400 Post Office Drawer 11300 Tallahassee, Florida 32302

Attorney for Life Care Centers of America (U. S. Mail)

James H. Harris, Esquire Office of the General Counsel

Agency for Health Care Administration (Interoffice Mail)

Richard Joseph Saliba, Esquire Office of the General Counsel

Agency for Health Care Administration (Interoffice Mail)

Jan Mills

Facilities Intake Unit

Agency for Health Care Administration (Interoffice Mail)

Office of Finance and Accounting Revenue Management Unit

Agency for Health Care Administration (Interoffice Mail)

MAR-17-2009 10:39 AGENCY HEALTH CARE ADMIN

Mar 17 2009 10=25

850 921 0158

P.08

STATE OF PLORXDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OP P'LORIDA# AGENCY FOR

HEAL'l'B CAaB ADMINISTRATIO .

Petitioner,

vs. Case No. 2008013528

LIFE CARE HEALTH RESOURCSS, INC., d/b/a LifB CARE CENTER OF SARASOTA,

Respondent.

-- ----------/

ADMINIBTRATXVE COMPLA:Im"

Petitioner, the Florida Agency for Health Care Administration ( \\AHCA11 ) , through undersigned counsel, files

this Administrative Complaint against the above-named

r· .,,' '

Respondent (\\Respondent"Y':r,ursuant to Sections 120.569 and

1. , Florida Statutes (2007)l, and alleges:

   
   

   NATUR.E OF THB ACTION

   
   

   1. This is an action to impose an administrative fine in the amount of $3,239 (the -fine. a.mountN) against Respondent, pursuant to Section 408.040, Florida Statutes, and Florida Administrative Code Rule 59C-l.021.

   2. For the calendar year 2007 (the ncale11dar year"),

      
      

      Respondent failed to comply with the Medicaid condition upon

      
      

      Page l of 11

      
      

      EXHIBIT 1

      
      

      its Certificate of Need (aCON"), a copy of which is attached to this complaint as Exhibit A.

      JWU:SDICTION AND VBNTJE

      
      

   3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031-408.045, Florida's Health Facility and Services Development Act."

   4. Venue is determined by Florida Administrative Code

Rule 28-106.207.

PAR.TIBS

s. Pursuant to Chapter 408, Florida Statutes, and

Chapter 59C-1, Florida Administrative code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules.

1. Respondent is a corporation authorized under the laws of Florida to do business. Respondent operates a community nursing home located at 8104 North Tuttle Avenue, Sarasota, Florida 34243 and is the licensee on the CON issued on November 13, 1994 for a minimum of 34.36% of the 120 bed facility's total annual patient days shall be provided to Medicaid patients. The CON number is 7904: a copy of the CON is attached to this complaint as Exhibit A,

   
   

   1Unless otherwise noted, all statutes and rules hereinafter cited are to the indicated year's version of the statute or

   
   

   
   

   COUNT ::C

   
   

   Respondent failed to meet its Medicaid condition Section 408.040, Florida St•tutee

   Florida Ac::binistrative Code Rule 59C-1.021

   
   

2. AHCA re-alleges paragraphs 1 6 above,

a. Respondent failed to comply with its Medicaid condition as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which iB attached to this complaint as Exhibit B. The facility

responded to a request to provide a facility report, a copy of

the report is attached to this complaint as Exhibit C.

9. Respondent failed to comply with the condition set

forth in its CON, as required by Section 408.040, Florida

' ' ',}

1

Statutes, which provide, in part, aa follows:

408.040 Conditions and monitoring

(1) (a) The agency may issue a certificate of need, or an exemption, predicated upon statements of intent expressed by an applicant in the application for a certificate of need. 'Jwy conditions imposed on a certificate of need or an exemption based on such statements of intent shall be stated on the face of the certificate of need or in the exemption approval,

1. The agency may consider, in addition to the other

   criteria specified ins. 408.035, a statement of intent by the applicant that a. specified percentage Ot' the annual patient days at the facility will be utilized by patients eligible tor care under Title XIX of the Social Security Act. Any certificate of need issued to a nursing home in reliance upon an applicant's statements that a specified percentage of annual patient days will be utilized by residents eligible for care under Title XIX of the Social security Act must include a statement that such certification ie a condition of issuance of

   
   

   rule because this is the controlling year in question.

   
   

   
   

   the certificate of need. The certificate-of-need program shall notify the Medicaid program office and the Department of Elderly Affairs when it imposes conditions aa authorized in this paragraph in an area in which a community diversion pilot project is implemented.

2. A certificate holder or an exemption holder may apply to the agency for a. modification of conditions imposed under paragraph (a) or para.graph (b}. If the holder of a certificate of need or an exemption demonstrates good cause why the certificate or exemption should be modified, the agency shall reissue the certificate of need or exemption with such modifications

   a.e may be appropriate. The agency shall by rule define the factors constituting good cause for modification.

3. If the holder'--'of a certificate of need or an

exemption fails to comply with a condition upon which the issuance of the certificate or exemption waa predicated, the agency may assess an administrative fine against the certificate holder in an amount not to exceed $1,000 per failure per day. Failure to annually report compliance with any condition upon which the issuance of the ce:r.:-tificate or exemption was predicated constitutes noncompliance. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance.. Proceeds of such penalties shall be deposited in the Public Medicaid Assistance Trust Fund.

* * *

10, The foregoing violation warrants impoaition of the above-mentioned fine amount pursuant to Florida

.

Administrative Code R r9C-l.02l, which provides, in part:

59C-1.021 Penalties.

Cl) General Provisions. The agency shall initiate administrative proceedings for revocation of a certificate of need for "lfiolation of paragraphs 408.040(2) (a) and (b), F.S., or the assessment of administrative fines for failure to comply with conditions placed on a certificate of need as specified under Rule 59C-l,013, F.A.C

(3) Penalties for Failure to Comply with certificate

of Need conditions. The agency shall review the annual

Page 4 of ll

compliance report subm tted by the health ca e providers who are licensed and operate the facilities or services and other pertinent data to assess compliance with certificate of need conditions, Providers who are not in compliance with certificate of need conditions shall be fined. For community nursing homes or hospital-based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions muat be submitted 30 calendar days following the eighteenth month of operation or the first month where 85 percent occupancy is achieved, whichever comes first. The schedule of fines is as follows:

1. Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a tine, not to exceed $1,000 per failure per day. In asseseing the penalty the agency shall take into account the degree of noncompliance.

   ±f

2. The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency .action if an . administrative hearing has been requesteq!: a h alth care provider desires it may remit payment·· according to a payment schedule accepted by the agency. Th@ health care provider must submit the schedule of payments to the agency within 30 calendar days after the date of receipt of the

notification of assessment or 21 calendar days after final agency action. The final balance will be due no later than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 montha after final agency action.

11. AliCA, in determining the penalty imposed, considered the degree of noncompliance.

WHEREFORE, AHCA requests the following relief: (l) enter

factual and legal findings a.e set forth in this Count; (2)

impose the above-mentioned fine amount for the violation; and

1. impose such other 'relief as this tribunal may find appropriate.

NOTICE

RESfONDENT is hereby 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 (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agenay £or.Health Care Admini11t:,;ation, 27Z7 .Mahan Dr Bldg. 3, MS #3, TallahaBsee,

Florida, 32308; Attention: Agency Clerk.

RBSPONl>ENT lS P'CJR.THER. NO'l':tP'IED THAT IF THE RBQ'O'BST POR HEARING XS NOT RBCBIVBD BY THE AGENCY FOR HEALTH CARE ADMlNISTRATION WITH!H 'l'WENTY-0:NE (21) DAYS OP RECEIPT OP THIS APMIN:ISTRATIVE COMPLAINT, A PINAL ORDER WILL BE ENTERED.

Submitted as of the date indicated on the below Certificate of Service.

mes H, Harris

sistant General counsel

a. Bar No. 817775

Agency for Health Care

Administration

525 Mirror Lake Drive, North

Suite 330H

St. Petersburg, Florida 33701

Phone: 727-552-1435

F X: 727-552-1440

CBR.TIPICATE OF SERVICE

I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent:

1. by U.S. Certified Mail, Return Receipt Requested, Receipt# 7007 0220 0001 1589 3430 to Life Care Center of Sarasota, Attention: Administrator, at 8104 North Tuttle Avenue, Sarasota, Florida 34243;

   
   

2. by U.S. Certified Mail, Return Receipt Requested, Receipt# 7007 0220 0001 1589 3447 to C.T. Corporation System, Registered Agent for Clay County Medical Investors, LLC, 1200 South Pine Island Road, Plantation, Florida 33324; and

   
   

3. by regular U.S. Mail to John F. Gilroy, IlI, P.A., 1435 East Piedmont Drive, Suite 215, Tallahassee, Florida 32308

   on December [y, 2008,

   ....

   es Harris, Esq.

   sistant General Counsel

   
   

   BTATB OF PLOR.IOA

   AGEN'CY FOR HEALTH. CARE ADMINISTRATION

   STATE OP FLORIDA, AGENCY FOR

   HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   Vd. Case No. 2008013522

   
   

   CLAY COUNTY MEDICAI, INVESTORS, LLC d/b/a LIFE CARE CENTER OP ORANGE PAR.IC

   
   

   Respondent.

   - -----------/

   ADMINISTRATIVE COMPI.aAIN'l'

   Petitioner, the Florida Agency -for Health care Administration ("AHCA"), through undersigned counsel, files this Administrative Complaint against the above-named Respondent ("Respondent") pursuant to Sections 120.569 and 120,57, Florida Statutes (2007}1, and alleges:

   NATURE OF THE ACTION

   
   

   l. This is an action to .impose an administrative fine in the amount of $6,643 (the ''Pine Amo\Ul.t"} against Respondent, pursuant to section 408.040, Florida Statutea, and Florida Administrative Code Rule s c-1.021.

   
   

   1 Unl e s s otherwise noted, all statutes and rules hereinafter cited a.re to the indicated year's version of the statute or rule because this is the controlling year in question,

   
   

   1. For the calendar year 2007 (the "Calendar Yearu), Respondent failed to comply with the Medicaid condition upon its Certificate of Need ("CONN), a copy of which is attached to this complaint as Exhibit A.

      JURISDICTION AND VENUE

      
      

   2. This tribunal has jurisdiction over Respondent, pureuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031-408,045, Florida's "Realth Facility and Services Development Act."

4 . Venue ia determined by Florida Administrative Code

Rule 28-106.207.

PARTIES

5, Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules.

1. Respondent is a limited liability company authorized under the laws of Florida to do business. Respondent operates a community nursing home located at 2145 Kingsley Avenue, orange Park, Florida 32703 and ie the licensee on the CON issued on September 19, 1995 for a minimum of 53,55% of the 180 bed facility's total annual patient days shall be provided to Medicaid patients. The CON nu ber is 7737; a copy of the CON

   is attached to this complaint as Exhibit A.

   I '

   
   

   
   

   COUNT I

   
   

   Respondent failed to meet its Medicaid condition

   Seeticn 408.040, Flo ida statutes

   FloTida Administrative Code Rule 59C-l.021

   
   

2. ARCA re-alleges paragraphs 1-6 above.

8, Respondent failed to comply with its Medicaid condit.ion as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which is attached to this complaint as Exhibit B, The facility responded to a request to provide a facility report, a copy of the report is attached to this complaint as Exhibit C.

1. Respondent failed to comply with the condition set forth in its CON, as required by Section 408.040, Florida Statutes, which provide, in part, as follows:

   408.040 Conditions and monitoring

   (l) (a) The agency may issue a certificate of need, or an exemption, predicated upon statements of intent expressed by an applicant in the application for a certificate of ne'ed. Fi.ny conditions imposed on a certificate of need or an exemption baaed on such statements of intent shall be stated on the face of the certificate .of need or in the exemption approval.

   1. The agency may consider, in addition to the other criteria specified ins, 408.03S, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utilized by patients eligible for care under Title XIX of the Social securit.y Act. Any certificate of need issued to a nursing home ·in_ reliance upon an applicant I s statements chat a specified percentage of annual patient days will be utilized by residents e;tigible for care under Title

      XIX of the Social Security Act must include a statement that such certification is a condition of issuance of the certificate of need. The certificate of-need program

      
      

      
      

      shall notify the Medicaid program office and the Department of Elderly Affa.i.rs when it imposes conditions as authorized in this paragraph in an area in which a. community diversion pilot project is implemented.

   2. A certificate holder or an exemption holder may apply to the agency for a modification of conditions imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need or an exemption demonstrates good cause why the certificate or exemption should be modified, the agency shall reiaaue the certificate of need or exemption with such modifications as may be appropriate. The agency aha.ll by rule define the factors constituting good cause for modification.

   {d) If the holder of a certificate of need or an

   exemption fails to comply with a condition upon which the issuance of the certificate or exemption was predicated, the agency may assess an administrative fine against the certificate holder in an amount not to e:x:ceed $1 1 000 per failure per day. Failure to annually report compliance with any condition upon which the issuance ,o , the certificate or exemption was predicated cori'sti tutes noncompliance. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance. Proceeds of such penalties shall be deposited in the Public Medicaid Assistance Trust Fund.

   * * *

   
   

2. The foregoing violation warrants imposition of the above-mentioned fine amount pursuant to Florida Administrative Code Rule 59C-l.021, which provides, in part:

   59C l.02l Penalties.

   1. General Provisions. The agency shall initiate administrative proceedings for revocation of a certificate of need for violation of paragraphs 408.040(2)(a) and {b), F.S., or the assessment of administrative fines for fail,ure to comply with conditions placed on··a· certificate of need as specified under Rule 59C-1.013, F.A.C

      
      

      ( 3) Penalties for Failure to Comply with Certificate of Need Conditions. The agency shall review th@ annual compliance report submitted by the health care providers

      
      

      
      

      who are licensed and operate the facilities or services and other pertinent data to assess compliance with certificate of need conditione. Providers who are not in compliance with certificate.of need conditions shall be fined. For community nursing homes or hospital-based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions must be submitted 30 calendar days following the eighteenth month of operation or the first month where an 85 percent occupancy is achieved, whichever cornea first. The schedule of fines is as follows:

      1. Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a fine, not to exceed $1,ooo per failure per day. In

         assessing the penalty the agency shall take into account the degree of noncompliance.

         (bl The assessed fine sha.ll be paid to the agency

         within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an administrative hearing has been requested. If a health care provider desires it may remit payment according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments to the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 calendar days after final agency a.ction. The final balance will be due no later than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 months after final agency action.

         
         

3. AHCA, in deterniiriing the penalty imposed, considered the degree of noncompliance.

WHERSFORB, AHCA demands the following relief: (1) enter factual and legal findings as set forth in this Count; (2) impose the above-mentioned fine amount fqr the violation; and

(3) impose such other relief as this tribunal may find appropriate.

ROTI:CE

RESPONPENT is hereby notified that it has a right to request an administrative hearing pureuant to Section 120. 569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page) . All requests for hearing shall .be made to the Agency for Health Care Administration and delivered to the Ageney for Health care Admin.istrae-.ton,. 2727 Jlfaban Dr., Bldg. 3, MB #3, Ta1lahaa•ee, Florida, 32308; Attent1on: Ag noy Clerk.

RESPONDENT lS Ptm.THER NOTIFIED THAT IF THR REQUBST FOR HBARINQ IB NOT R.EC!:IVED BY THE AGKNCY FOR HEALTH CARE ADMINISTRATION WITHI.N TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL O ER Wl'LL BE ENTERED.

Submitted as of the date indicated on the below

Certificate of Service.

mes H. Harris

sistant General Counsel

Fa. Bar NO. 817775

Agency for Health Care Administration

525 Mirror Lake Drive, North Suite 330H

St. Petersburg, Florida 33701 Phone: 727 552-1435

Fax: 727-552-1440

CBRTlFICATE OF SERvrCE

I HEREBY CERT FY that a copy of the original Administrative complaint, Explanation of Rights form, and Election of Rights form have b en sent:

1. by u.s. certified Mail, Return Receipt Requested, Receipt#

7007 0220 0001 1589 3454 to Life Care Center of orange Park, Attention: Administrator, at 2145 Kingsley Avenue, orange Park, Florida 32703;

2, by u.s. Certified Mail, Return Receipt Requested, Receipt# 7007 0220 0001 1589 3461 to C.T. Corporation System, Registered Agent for Clay County Medical Investors, LLC, 1200 South Pine Island Road, Plantation, Florida 33324; and

1. by regular U.S. Mail to John F. Gilroy, III, P.A., 1435 Bast Piedmont Drive, suite 215, Tallahassee, Florida 32308

   on December f 2- , 2008,

   
   

   mes H. Harris, Esq. sistant General Counsel

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION ·

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs.

   
   

   New Port Richey M.edical Investors, LLC

   d/b/a Life Cnre Center of New Port Richey

   
   

   Respondent.

   I

   
   

   ADMINISTRATIVE COMPLAINT

   Petitioneri the Florida Agency for Health Care Administration ("AHC4"), through undersigned counsel, files this Administrative Complaint ag3inst the above-named Respondent ("Respondent") pursuant to Sections 120.569 and 120.57. Florida Statutes (2007J1 and alleges:

   NATURE OF THE ACTION

   1. This is an action to impose an administrative fule in 1he amoun.t of. S:ix:tee:o.

      
      

      Thousand Six Hundred Forty Fom Dollars ($16,644.00) (the ;'fine amount'? against Respondent pursuant to Section 408.040, Florida Statutes, and Florida Administrative Code Rule 59C-l.021.

      
      

      1 Un Jess otherwise noted. all statutes and rules hereinafter cited are to the indicated year's

      version of the statute or rule because lhis is the controlling year in question.

      
      

      Page I of9

   2. For the calendar year 2007 (the "calendar year"), Respondent failed to comply with the Medicaid condition upon its Certificate of Need ("CON"), a copy of which is attached to this complaint as Exhibit A.

      JURISDICTION AND VENUE

      
      

   3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031- 408.045, Florida's "Health Facility and Services Development Act."

   4. Venue is determined by Florida Administrative Code Rule 28-106.207.

      
      

      PARTIES

      
      

   5. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-l, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules.

   6. Respondent is a corporation authorized under the laws of Florida to do business.

      
      

      Respondent operates a community nursing home located at 7400 Trouble Creek Road, New Port Richey, Florida 34653 and is the licensee on the CON issued on May 6, 1998 for a minimum of 25.50% of the 113 bed facility's total annual patient days shall be provided to Medicaid patients. The CON number is 8813; a copy of the CON is attached to this complaint as Exhibit A.

      COUNTI

      
      

      Respondent failed to meet its Medicaid condition Section 408.040, Florida Statutes

      Florida Administrative Code Rule 59C-1.021

      
      

   7. AHCA re-alleges paragraphs 1-6 above.

      APR-17-2009 16=18 AGENCY HEALTH CARE ADMIN

      850 921 0158 P.21/29

      
      

   8. Respondent failed to comply with its Medicaid condition as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which is attached to this complaint as Exhibit B. The facility responded to a request to provide a

      facility report. a copy of the report is attached to this complaint as Exhibit C.

      
      

   9. Respondent failed to comply with the condition set forth in its CON, as required by

      
      

      Section 408.040, Florida Statutes, which provide, in part, as follows:

      
      

      408.040 Conditions and monitoring

      (l)(a) The agency may issue a certificate of need, or an exemption, predicated upon statements of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need or an exemption based on such statements of intent shall be stared on the face of the certificate of need or in the exemption approval.

      1. The agency may consider, in addition to the other criteria specified in .s. 408.035, a statemem of intent by the applicant that a specified percentage of the annual patient days at the facility will be

         utilized by patients eligible for care under Title XIX of the Social Security /\ct. Any certificate of need issued to a nursing home in reliance upon an applicant's statements that a specified percentage of annual patient days will be utilized by residents eligible for care under Title XIX of the Social Security Act must include a statement that such cenification is a condition of issuance of the certificate of need. The certificate-of-need program shall notify !he Medicaid program office and the Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented.

      2. A certificate holder or an ex.emption holder may apply to the agency for a modification of conditions imposed under paragraph (a) or p;.u-a,graph (b). lf the holder of a certificate of need or an exemption demonstrates good cause why the certificate or exemption should be modified, the agency shall reissue the certificate of need or exemption with such modifications as may be appropriate. The agency shall b:y rule define the facwrs constituting good cause for modi6catio.n,

         ..

      3. If the holder of a certificate of need or an exemption fails to comply with a condition upon which the issuance of the certificate or exemption was predicated, the agency may assess an administrative fine against the certificate holder ir.i an amount not to exceed $1,000 per failw-e per day. Failure to annually report compliance with any condition upon which the issuance of the certificate or exemption was predicated constitmes noncompliance. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance. Proceeds of such penalties shall be deposited in the :Public Medicaid Assistance Trust Fund.

      ... ,.,

      
      

   10. The foregoing violation warrants imposition .of the above mentioned fine amount pursuant to Florida Administrative Code Rule 59C-l.021, which provides, in part:

       59C-1.02l Penalties.

       1. General Provisions. The agency shall initiate admini trative proceedings for revocation of a certlficate of nt!ed for violation of paragraphs 408.040(2)(a) and (b), F.S., or the as$essment of administrative fines for failure to comply with conditions placed on a certificate of need as -specified under Rule 59C-J.0l3, F.A.C

          APR-17-2009 16:19 AGENCY HEALTH CARE ADMIN

          850 921 0158 P.22/29

          
          

          1. Penalties for Failure to Comply with Certificate of Need Conditions. The agency shall review the annual compliance l'eport submitted by the health care providers who are licensed and operate the facilities or services and other pertinent data to assess compliance with certificate of need conditions. Providers who are not in compliance with certificate of need conditions shall be fined. For communi1y nursing homes or hospital-based skilled nursing units certified as such by Medicare, the fuSt compliance report on the status of conditions mus1 be submitted 30 calendar days following the eighteenth month of operation or the first rnonth where an 85 percent occupancy is achieved, whichever co.mes first. The schedule of fines is as follows:

             1. Facilities failing to comply with any conditions set forth on the Certificate of Need will be a$sessed a fine, not to exceed $1,000 per failure per day. 1n assessing the penalty the agency shall take into account the degree of noncompliance.

             2. The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an administrative hearing has been requested. Jf a health care provider desires it may remit payment according to a paymem schedule accepted by the agency. The health care provider must submi1 the schedule of payments to the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 caJendaT days after final agency action. The final balance will be due no later than 6 months after rhe health care provider has been notified in writing by the agency of the amount oftl1e assessed fine or 6 months after final agency action.

   11. AHCA, in determining the penalty imposed, considered the degree of noncompliance.

WHEREFORE, AHCA demands the following relief: (1) enter factual and legal findings as set forth in this Count; (2) impose the above-mentioned fine amount for the violation; and (3) impose such other relief as this tribunal may find appropriate.

NOTICE

RESPONDENT is hereby 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 (one page) and explained in the attached Explanation of Rights (one page). :All requests for hearing shall be made to the Agency for Health Care Administration and,delivered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Clerk,

RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED.

Submitted as of the date indicated on the below Certificate of Service.

Agency for Health Care Administratjon

Richard Joseph Saliba, Esquire Senior Attorney

Fla. Bar No. 0240389

Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MS #3

Tallahassee, Florida 32308

Phone: (850) 922-5873

Fax: (850) 921-0158 or 413-9313

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail,

Return Receipt Requested (receipt# 7004 2890 0000 5527 2449) to Respondent, Attention: Administrator, at 7400 Trouble Creek Road, New Port Richey, Florida 34653 on this fi-ti1

day of February 2009.

Agency for Health Care Administration

• I ( !"'/r.

,..-k; """,/,..., #. H. r-f.l \,-.;I-1:\.,•\

Richara Joseph Saliba, Esquire Senior Attorney

Fla. Bar No. 0240389

Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3. MS #3

Tallahassee, Florida 32308

Phone: (850) 922-5873

Fax: (850) 921-0158 or 413-9313

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

vs. . Case No. 2009000369

Life Care Centers of America, Inc. d/b/a Life C,u·e Center of Port St. Lucie

Respondent.

!

ADMINISTRATIVE COMPLAINT

Petitioner, the Florida Agency for Health Care Administration eAHCA"),

through undersjgned counsel, files this Administrative Complaint against the above naroed

)

Respondent (''Respondent'1 pursuant to Sections 120.569 and 120.57, Florida Statutes (2008),1

and alleg1;1s:

NATURE OF THE ACTION

1. This is an action to impose an administrative fine in the am.ount. o · Fifteen Thousand Three Hundred Two Dollars ($15,302) (the "fine amount'? against R spondent, pursuant to Section 408.040, Florida Statutes, and Florida Administrative Code Rule 59C­ I.02I.

   
   

   1 Unless mherwise noted, all statutes and 1ulcs hereinalter cited are to the indicated year's version of the statute or rule because this is the controlling year in question.

   
   

   Page I of9

   APR-17-2009 16=34 AGENCY HEALTH CARE ADMIN

   850 921 0158 P.21/31

   
   

2. For the calendar year 2007 (the "calendar year"), Respondent failed to comply

   with the Medicaid condition upon its Certificate of Need ("CONH), a copy of which js attached

   
   

   to this complaint as Exhibit A.

   
   

   JURISDICTION AND VENUE

   
   

3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and I20.57i Florida Statutes, and also Sections 408.031- 408.045, Florida's "Health Facility and Services Development Act."

4. ·venue is determined by FloridaAdministrafrve Code Rule 28-106.207.

   
   

   PARTIES

   
   

5. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules.

6. Respondent is a corporatjon authorized under the laws of Florida to do business.

·Respondent operates a community nursing home located at 3720 SE Jennings Road, Port St. Lucie Florida 34952 and is the licensee on the CON issued on May J 9,1998 for a minimum of 47.00% of the 123 bed faciliry's total annual patient days .shall be provided to Medicaid patients. The CON number is 8975; a copy of the CON is attached to this

• com.plaint as Exhibit A.

  
  

  COUNTI

  
  

  Respondent failed to meet its Medicaid condition Section 408.040, Florida Statutes

  Florida Administrative Code Rule 59C-J.021

  
  

  7, AHCA re-alleges paragraphs 1-6 above.

  APR-17-2009 15:35 AGENCY HEALTH CARE ADMIN

  850 921 0158 P.22/31

  
  

  1. Respondent failed to comply with its Medicaid condition as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which is attached to this complaint as Exhibit B. The facility responded to a request to provide a facility report, a copy of the report is attached to this complaint as Exhibit C.

  2. Respondent failed to comply with the condition set forth in its CON, as required by

     
     

     Section 408.040, Florida Statutes, which provide, in part, as follows:

     
     

     408.040 Conditions and monitoring

     (l)(a) The agency may issue a certificate of need, or .an exemption, predicated upon statemenrs of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need or .an exemption based on such statements of intent shall be stated on the face of the certificate of need or in the exemption approval.

     1. The agency may consider, in addition to the other criteria specified ins. 408.035, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utili:,..ed by patients eligible for care under Title XIX of the Social Security Act. Any certificate of need i sued to a nursing home in relianc up-on an applicant's tatements that a specified percentage of annual patient days will be utilized by residents eligible for care under Title XIX of the Social

        • Security Act must include a statement that such certification is a condition of issuance of the certificatt: of need. The certificate-of-need program shal notify the Medicaid program office and the Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community_diver5ion pilot project is implemented.

1. A certificate holder or an exemption_ holder may apply to the agency for a modification of wad itions imposed under paragraph (a) or paragraph (b). lf the holder of a certificate of need or an exemption demonstrates good cause why the certificate or exemption should be modified,- the agency shall rei$SUe the cenificate of need or exemption with such modifications as may be appropriate. The agency shall by rule define the factors constituting good cause for modification.

2. If the holder of a certificate of need or an exemption fails io comply with a condition upon which the issuance of the certificate or exemption was predicated, the agency may assess an admi.nisti:ative fine against the certificate holder in an amount not to exceed $1,000 per failw-c per day. Failure to annually report compliance with any condition upon which the issuance of the certificate or ex.emption was predicated constitutes noncompliance. In assessing the penalty, tbt) agency shall t11ke into account as mitigation rhe. degree of noncompliance. Proceeds of such penalties shall be deposited in the Public Medic11id Assistance Trust Fund.

• • *

1. The foregoing violation warrants ·imposition of the above-mentioned fine amount

   
   

   pursuant to Florida Administrative Code Rule 59C-1.021, which provides, in part:

   
   

   59C-1.021 Penalties.

   1. General Provisions. The agency shall initiate administrative proc edings for revocation of a certificate of need for vio\arion of paragraphs 408.040(2)(a) and (b), F.S., or the assessment of administrative fines for failure to comply witll condirions placed on a certificate of need as specified lll')d r Rule 59C-l.013, F.A.C

      APR-17-2009 16=35 AGENCY HEALTH CARE ADMIN

      850 921 0158 P.23/31

      
      

      1. Penalties for Failure to Comply with Certificate ofNeed Conditions. The agency shall review the annual compliance report submitted by the health care providers who are licensed and operate the facilities or services and othc:r pc:rtinent data to assess compliance with certificate of need conditions. Providers who are not in compliance with certificate of need conditions shall be fined. For community nursing homes or hospital-based skilled nursing units cenified as such by Medjca,-e, the first compliance report on the st.ams of conditions must be submitted 30 calendar days following the eighteenth month of operation or the first month where an 85 percent occupancy is achieved, whichever comes first. The schedule of fines is as follows;

         1. Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a fine, nor to exceed $1_,000 per failure per day. In assessing the penalty the agency shall take into account the degree of noncompliance.

         2. The a.. sessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if at1 administrative hearing has been requested. If a health care provider desires it may remit payment according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments 10 the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 calendar days after final agency action. The final balance will be due no later than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 months after final agency action.

2. ARCA, in determining the penalty imposed, considered the degree of noncompliance.

WHEREFORE, AHCA demands the following relief'. (1) enter factual and legal findings as set forth in this Count; (2) impose the above-mentioned fine amount for the violation; and (3) impose such other relief as this tribunal may find appropriate.

NOTICE

RESPONDENT is hereby notified that it has a right to re4uest an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). AH requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency for Health Care Administration, 2727 Mahan Dr.1 Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Clerk.

RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE. ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF• THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED.

Submitted as of the date indicated on the below Certificate of Service.

Agency for Health Care Administration

Richard'Joseph Saliba, Esquire Senior Attorney

Fla. Bar No. 0240389

Agency for Health Care Administrabon

2727 Mahan Drive, Bldg. 3, MS #3

Tallahassee, Florida 32308

Phone: (850) 922-5873

Fax: (850) 921-0158 or 413-9313

CERTJF1CATE OF SERVICE

I HEREBY CERTIFY that a copy of the original Administratjve Complaint, Explanation of Rights fonn, and Election of Rights fonn have been sent by U.S. Certified. Mail, Return Receipt Requested (receipt# 7004 2890 000 5527 2432) to Respondent, Attention: Administrator, a.t 3720 SE Jenni:t1gs Road, Pon St. Lucie Flo·dda 34952 on this· )( }( day of Febrnary 2009.

Agency for Health Care Administration

Ri w ;s b Salib , Esquire Senior Attorney

Fla. Bar No. 0240389

Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MS #3

Tallahassee, Florida 32308

Phone: (850) 922-5873

Fax: (850) 921-0158 or 413-9313

APR-17-2009 15:45 AGENCY HEALTH CARE ADMIN

850 921 0158 P.20/31

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

vs. Case No. 2009000371

Life Care Centers of Amer-ica, 'Inc. d/b/a Life Care Center of Ocilla

Respondent.

--- I

ADMINISTRATIVE COMPLAINT

Petitioner, the Florida Agency for Health Care Administration (''ARCA"), through undersigned counsel, files this Administratjve Complaint against the above-named· Respondent (''Respo1'1.dent'') pursuant to Sections 120.569 and 120.57, Florida Statutes (2007).\ and alleges:

NATURE OF THE ACTION

l. This is an ac1ion to impose an adminjstrative fine in the amount of Thirteen Thousand Six Hundred and Sixty Dollars ($13,660) (the "fine amount'J against Respondent, pursuant to Section 408.040, Florida Statutes, and Flo1ida Administrative Code Rule 59C-

:021.

1Unless otherwise nored, all statutes and rules hereinafter cited are to the indicated year's

version of the statute or rule because rhis is the controlling year in question.

APR-17-2009 16=45 AGENCY HEALTH CARE ADMIN

850 921 0158 P.21/31

1. For the calendar year 2007 (the "calendar year"), Respondent failed to comply with the Medicajd condition upon its Certificate of Need ("CON"), a copy of which is attached to this complaint as Exhibit A

   JURISDICTION AND VENUE

   
   

2. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031- 408.045, Florjda's ''Health Facility and Services Development Act. • .

3. Venue is determined by Florida Administrative Code Rule 28-106.207.

   
   

   PARTIES

   
   

4. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1 Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules.

5. Respondent is a corporation authorized under the laws of Florida to do business.

   
   

   Respondent operates a community nursing home located at 2800 SW 41st Street, Ocala Florida 34474 and is the licensee on the CON issued on January 26, 1996 for a minimum of 33.00% of the 120 bed facility's total annual patient days sh.all be provided to Medicaid

   patients. The CON number is 7923; a copy of t e CON is attached to this complaint as

   
   

   Exhibit A.

   
   

   COUNTI

   
   

   Respondent failed to meet its Medicaid condition Section 408.040, Florida Statutes

   Florida Administrative Code Rule 59C-1.021

6. AHCA re-alleges paragraphs 1-6 above.

   APR-17-2009 16:45 AGENCY HEALTH CARE ADMIN 850 921 0158 P.22/31

   
   

7. Respondent failed to comply with its Medicaid condition as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which is attached to this complaint as Exhibit B. The facility responded to a request to provide a facility report, a copy of the report is attached to this complaint as Exhibit C.

8. Respondent failed to comply with the condition set forth in its CON, as required by Section 408.040, Florida Starutes, which provide, in part, as follows:

408.040 Conditions and monitoring

(J)(a) The agency may iss1-1e a certificate of need, or an exemption, predicated upon statements of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need or an exemption ba:si:.d on such statements of intent shall be stated on the face of the certificate of need or in the exemption approval.

1. The agency may consider, in addition to the other criteria sp cified jn s. 408.035, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utilized by patients eligible for care under Title XIX of the Social Security Act. Any certificate of need 1$sued to a nursing home in reliance upon an applicant's statements that a specified percentage of annual patient days will be utilized by residents eligible for care under Title XIX of the Social Security Act musr include a srntemem mar such certification is a condition of i.ssuance of the certificate of need. The certificate-of-need program shall notify the Medicaid program office and Ihe Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented.

2. A certificate holder or an exemption holder may apply to the agency for a modification of conditions imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need or m exemption demonstrates good cause why the certificate or exemption should be modified, the agel')cy shall reissue the certificate of need or exemption with such modifications as may be appropriate. The agency shall by rule define the factors constituting good ca1.1se for modification.

3. lf the holder of a certificate of need or an exemption fails to comply with a condition

upon which the issuance of the certificate or exemption was predicated, the agency may assess an adminii;;trative fine again l rhe certificate holder in an amount not to exceed $1,000 per failure per day, Failure to annually report compliance with any condition upon which the issuance of the certificate or exemption was predicated constitutes noncompliance. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance. Proceeds of such penalties shall be deposited in The Public Medicaid Assistance Trust Fund.

* * *

I 0. The foregoing violation warrants imposition of the above-mentioned fine amount pursuant to Florida Administrative Code Rule 59C-l .02 l, which provides, in part:

59C-l.021 Penalties.

1. GencraJ Provisions. The agency shall initiate administrative proceedings for revocati911 of a certificate of need for violation of paragraphs 408.040(2)(a) and (b), F.S., or the assessment of administrative fines for failure to comply with conditions placed on a certificate of need as specified underRule59C•l.013, F.A.C

* * *

1. Penalties for Failure to Comply with Certificate of Need Conditions, The agency shall review the annual compliance report submitted by the health care providers who are licensed and operate Ihe facilities or services and other pertinent data lo assess compliance with ceniflcate of need conditions. Providers who are not in compliance with certificate of need conditions shall be fined. For

   community nursing homes or hospital•based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions must be submitted 30 calendar days following me eighteenth month of operation or the first momb where an 85 percent occupancy is achieved,

   whichever comes first. The schedule of fines is as follows:

   1. Facilities failing to comply with any conditions set forth on the Cen:iflcate of Need will be assessed a fine, not to exceed Sl,000 per failure per day. In assessing the penalty the agency shall take into account the degree of noncompliance

   2. The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an admini,strative hearing has been requested. If a health care provider desires it may remit payment according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments to the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 calendar days after final agency action. 1'he final balance will be due no later than 6 months after the health c:arc provider has been notified in-writing by the agency of the amount of the assessed fine or 6 months after final agency action.

1. AHCA1 in determining the penalty imposed, considered the degree of noncompliance.

   
   

   WHEREFORE, AHCA demands the following relief: (1) enter factual and legal findings as set fonh in this Count; (2) impose the above-mentioned fine amount for the violation; and (3) impose such other relief as this tribunal may find appropriate.

   NOTICE

   RESPONDENT is hereby 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 (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration and deli ered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3_, Tallahassee, Florida, 32308; Attention: Agency Clerk.

   
   

   RESPONDENT IS FURTHER NOTlFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF TIDS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED.

   
   

   Submitted as of the date indicated on the below Certificate of Service.

   
   

   Agency for Health Care Administration

   
   

   Ricaraseph Salib , Esquire Senior Attorney

   Fla. Bar No. 0240389

   Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MS #3

   Tallahassee, Florida 32308

   Phone: (850) 922ff5873

   Fax: (850) 921-0158 or 413 9313

   
   

   CERTIFICATE OF SERVICE

   I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail,

   • Return Receipt Requested (receipt# 7004 2890 000 5527 2425) to Respondent, Attention: Administrator, at 2800 SW 41st Srrect, Ocala frlorida 3447'4 on thJS :H-r day of February 2009.

   
   

   Agency for Health Care Administration

   
   

   Senior Attorney

   Fla. Bar No. 0240389

   Agency for Health Care Administration

   2727 Mahan Drive, Bldg. 3, MS #3

   Tallahassee, Florida 32308

   Phone: (850) 922-5873

   Fax: (850) 921-0158 or 413-9313

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs. Case No. 2008013532

   
   

   MELWOOD NURSING CENTER, LLC d/b/a LIFE CARE CENTER OF MELBOURNE,

   
   

   Respondent.

   !

   
   

   ADMINISTRATIVE COMPLAINT

   
   

   Petitioner, the Florida Agency for Health Care Administration ("AIICA"), through undersigned counsel, files this Administrative Complaint against the above-named Respondent ("Respondent") pursuant to Sections 120.569 and 120.57, Florida Statutes (2007) 1 , and alleges:

   NATURE OF THE ACTION

   
   

   1. This is an kbtion to impose an administrative fine in the amount of $2,367 (the "fine amount") against Respondent, pursuant to Section 408,040, Florida Statutes, and Florida Administrative Code Rule 59C-l. 021".

   2. For the calendar year 2007 (the "calendar year"),

      Respondent failed to comply with the Medicaid condition upon

      
      

      ) Page 1 of 11

      
      

      its Certificate of Need {"CON"), a copy of which is attached to this complaint as Exhibit A.

      JURISDICTION AND VENUE

      
      

   3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031- 408.045, Florida's "Health Facility and Services Development Act."

   4. Venue is determined by Florida Administrative Code Rule 28-106.207.

PARTIES

s. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-l, Florida Administrative Code, AHCA is the

licensing and enforcing authority with regard to community nursing home laws and rules.

1. Respondent is a corporation authorized under the laws of Florida to do business. Respondent operates a community nursing home located at E. Sheridan Road, Melbourne, Florida 32901 and is the licensee on the CON issued on October 20, 1987 for a minimum of 45% of the 120 bed facility's total annual patient days shall be provided to Medicaid patients. The CON number is 3828; a copy of the CON is attached to this complaint as Exhibit A.

   1Unless otherwise noted, all statutes and rules hereinafter cited are to the indicated year's version of the statute or

   
   

   Page 2 of 11

   
   

   
   

   COUNT I

   
   

   Respondent failed to meet its Medicaid condition Section 408.040, Florida Statutes

   Florida Administrative Code Rule 59C-l.021

   
   

2. AHCA re-alleges paragraphs 1-6 above.

   
   

3. Respondent failed to comply with its Medicaid condition as reported to the Agency in its Florida Nursing Home Utilization Report for the year 2007, a copy of which is attached to this complaint as Exhibit B. The facility responded to a request to provide a facility report, a copy of the report is attached to this complaint as Exhibit C.

4. Respondent failed to comply with the condition set forth in its CON, as required by Section 408.040, Florida Statutes, which provide, in part, as follows:

   408.040 Conditions and monitoring

   (1)(a) The agency may issue a certificate of need, or an exemption, predicated upon. statements of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need or an exemption based on such

   statements of intent shall be stated on the face of the certificate of need or in the exemption approval.

   (b) The agency may consider, in addition to the other criteria specified ins. 408.035, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utilized by patients eligible for care under Title XIX of the Social Security Act. Any certificate of need issued to a nursing home in reliance upon an applicant's statements that a specified percentage o annual patient days will be utilized by residents eligible. for care under Title XIX of the Social Security Act must include a statement that such certification is a condition of issuance of

   
   

   rule because this is the controlling year in question.

   
   

   3 of 11

   
   

   
   

   the certificate of need. The certificate-of-need program shall notify the Medicaid program office and the Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented.

   (c} A certificate holder or an exemption holder may apply to the agency for a modification of conditions imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need or an ·exemption demonstrates good cause why the certificate or exemption should be modified, the agency shall reissue the certificate of need or exemption with such modifications as may be appropriate. The agency shall by rule define the factors constituting good cause for modification.

   (d) If the holder of a certificate of need or an exemption fails to comply with a condition upon which the issuance of the certificate or exemption was predicated, the agency may assess an administrative fine against the certificate holder in an amount not to exceed $1,000 per · failure per day. Failure to annually report compliance with any condition upon which the issuance of the certificate or exemption was predicated constitutes noncompliance. In assessing the penalty, the agency shall take into account as mitigation the degree of noncompliance. Proceeds of such penalties shall be deposited in the Public Medicaid Assistance Trust Fund.

   * * *

   
   

5. The foregoing violation warrants imposition of the above-mentioned fine amount pursuant to Florida Administrative Code Rule 59C-l.021, which provides, in part:

   59C-l.021 Penalties.

   1. General Provisions. The agency shall initiate administrative pr'obeedings for revocation of a certificate of need for violation of paragraphs 408.040(2)(a) and (b), F.S., or the assessment of administrative fines for failure to comply with conditions placed on a certificate of need as specified under Rule 59C-1.013, F.A.C

      * * *

      ( 3) Penalties for Failure to Comply with Certificate

      of Need Conditions. The agency shall review the annual

      
      

      
      

      compliance report submitted by the health care providers who are licensed and operate the facilities or services and other pertinent data to assess compliance with certificate of need conditions. Providers who are not in compliance with certificate of need conditions shall be fined. For community·• nursing homes or hospital-based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions must be submitted 30 calendar days following the eighteenth month of operation or the first month where 85 percent occupancy is achieved, whichever comes irst. The schedule of fines is as follows:

      1. Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a fine, not to exceed $1,000 per failure per day. In assessing the penalty the agency shall take into account the degree of noncompliance.

      2. The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an administrative hearing has been requested. If a health care provider desires it may remit payment according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments to the agency within 30 calendar days afte_f . the date· of receipt of the notification of assessment or 21 calendar days after final agency action. The final balance will be due no later than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 months after final agency action.

         
         

6. AHCA, in determining the penalty imposed, considered the degree of noncompliance.

WHEREFORE, AHCA requests the following relief: (1) enter factual and legal findings as set forth in this Count; (2) impose the above-mentioned fine amount for the violation; and

(3) impose such other relief as this tribunal may find appropriate.

NOTICE

RESPONDENT is hereby 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 (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Clerk.

RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OP THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED.

Submitted as of the date indicated on the below Certificate of Service.

s H. Harris

As stant General Counsel Fla. Bar No. 817775 Agency for Health Care Administration

525 Mirror Lake Drive, North Suite 330H

St. Petersburg, Florida 33701

Phone: 727-552-1435

Fax: 727-552-1440

CERTIFICATB OF SERVICE

I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent:

l. by U.S. Certified Mail, Return Receipt Requested, Receipt #7007 0220 0001 1589 3409 to Life Care Center of Melbourne, Attention: Administrator, at 606 East Sheridan Road, Melbourne, Florida 32901;

1. by U.S. Certified Mail, Return Receipt Requested, Receipt #7007 0220 0001 1589 3416 to C.T. Corporation system, Registered Agent for Clay County Medical Investors, LLC, 1200 South Pine Island Road, Plantation, Florida 33324; and

   
   

2. by regular U.S. Mail to John F. Gilroy, III, P.A., 1435 East Piedmont Drive, suite ·21s, Tallahassee, Florida 32308

on December ( '1-- , 2008.

mes H. Harris, Esq. sistant General Counsel

Page 7 of 11

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH CASE NO.: 09-1383 AHCA CASE NO.: 2008013528

LIFE CARE HEALTH RESOURCES, INC. d/b/a LIFE CARE CENTER OF SARASOTA,

Respondent. I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH CASE NO.: 09-1384 AHCA CASE NO.: 2008013522

CLAY COUNTY MEDICAL INVESTORS, LLC d/b/a LIFE CARE CENTER OF

ORANGE PARK,

Respondent. I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH CASE NO.: 09-2074 AHCA CASE NO.: 2009000372

NEW PORT RICHEY MEDICAL INVESTORS d/b/a LIFE CARE CENTER OF

NEW PORT RICHEY,

Respondent. I

EXHIBIT 2

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner, DOAH CASE NO.: 09-2076 AHCA CASE NO.: 2009000369

vs.

LIFE CARE CENTERS OF AMERICA, INC. d/b/a LIFE CARE CENTER OF

PORT ST. LUCIE,

Respondent. I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH CASE NO.: 09-2077 AHCA CASE NO.: 2009000371

LIFE CARE CENTERS OF AMERICA, INC. d/b/a LIFE CARE CENTER OF OCALA,

Respondent. I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH CASE NO.: 10-5421 AHCA CASE NO.: 2008013532

MELWOOD NURSING CENTER, LLC d/b/a LIFE CARE CENTER OF

. MELBOURNE,

Respondent. I

SETTLEMENT AGREEMENT

THE PARTIES, the State of Florida, Agency for Health Care Administration (hereinafter the "Agency"), through its undersigned representatives, and LIFE CARE HEALTH RESOURCES, INC. d/b/a LIFE CARE CENTER OF SARASOTA; CLAY

2

COUNTY MEDICAL INVESTORS, LLC d/b/a LIFE CARE CENTER OF ORANGE PARK; NEW PORT RICHEY MEDICAL INVESTORS d/b/a LIFE CARE CENTER OF NEW PORT RICHEY; LIFE CARE CENTERS OF AMERICA. INC. d/b/a LIFE CARE CENTER OF PORT ST. LUCIE; LIFE CARE CENTERS OF AMERICA.t INC. d/b/a LIFE CARE CENTER OF OCALA; MELWOOD NURSING CENTER LLC d/b/a LIFE CARE

CENTER OF MELBOURNE, ( hereinafter collectively referred to as "Life Care")

WHEREAS, 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 Agency filed Administrative Complaints for Life Care's failure to comply with Medicaid conditions placed on the CONs as specified under Rule 59C-l.013, F.A.C.

Life Care Center of Sarasota (CON 7904) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 34.36% of the 120 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $3,239.

Life Care Center of Orange Park (CON 7737) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 53.55% of the 180 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $6,643.

Life Care Center of New Port Richey (CON 8813) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 25.50% of the 113 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $16,644.

Life Care Center of Port St. Lucie (CON 8975) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 47.00% of the 123 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $15,302.

Life Care Center of Ocala (CON 7923) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 33.00% of the

3

120 bed facility's total patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $13,660.

Life Care Center of Melbourne (CON 3828) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 45% of 120 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $2,367.

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over for the review and approval applications pursuant to Chapter 400 and Section 120.569, and Section 120.57, Fla. Stat.; and

WHEREAS, the parties have negotiated 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 herein 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, Life Care, agrees to waive any and all appeals and proceedings related to these cases to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court of competent jurisdiction; and 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. The parties agree to settle this litigation as follows:

   
   

   1. Life Care Center of Sarasota (CON 7904) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 34.36% of the 120 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $3,239.

      
      

   2. Life Care Center of Orange Park (CON 7737) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 53.55% of the 180 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $6,643.

      
      

   3. Life Care Center of New Port Richey (CON 8813) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 25.50% of the 113 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $16,644.

      
      

   4. Life Care Center of Port St. Lucie (CON 8975) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 47.00% of the 123 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $15,302.

      
      

   5. Life Care Center of Ocala (CON 7923) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 33.00% of the 120 bed facility's total patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $13,660.

      
      

   6. Life Care Center of Melbourne (CON 3828) failed to comply with the Medicaid condition upon its CON. The CON required that a minimum of 45% of 120 bed facility's total annual patient days shall be provided to Medicaid patients. The fine amount determined by the Agency was $2,367.

      
      

   7. Life Care agrees to tender, and the Agency agrees to accept, payment in the amount of Five Thousand Seven Hundred and Eighty Dollars within thirty

      (30) days from date of the entry of the Final Order. This payment shall constitute full satisfaction of the amounts sought by the Agency relative to this enforcement action with regard to each of the Life Care facilities as set forth in paragraphs 4.1 through 4.6, above.

      
      

5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida.

   
   

6. Life Care acknowledges and agrees that this Agreement shall not preclude any other federal, state, or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the administrative complaint. This agreement does not prohibit the Agency from taking action regarding Life Care's Medicaid provider status, conditions, requirements, or contract.

7. 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 cases.

8. Each party shall be solely responsible for its respective costs and attorney's

   
   

   fees.

   
   

9. This Agreement shall become effective on the date upon which it is fully executed by all the parties.

10. Life Care for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from 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 Life Care or related facilities.

11. This Agreement is binding upon all parties herein and those identified in the initial paragraph in this Agreement.

12. In the event that Life Care was a Medicaid provider at the subject time of the occurrences alleged in the complaint herein, this settlement does not prevent the Agency

    
    

    from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions.

13. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it.

14. This Agreement contains and incorporates the entire understandings and agreements of the parties.

15. This Agreement supersedes any prior oral or written agreements between the

    
    

    parties.

    
    

16. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void.

17. All parties agree that a facsimile signature suffices for an original signature.

    
    

18. Life Care agrees that the Agency may file a Motion to Relinquish Jurisdiction these proceedings to the Agency from the Division of Administrative Hearings and that Life Care joins with that Motion to Relinquish. In the event that this agreement is not adopted by Final Order, either party may move to reopen these proceedings at the Division of Administrative Hearings.

THE REMAINER OF THIS PAGE LEFT INTENTIONALY BLANK

The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement.

AGENCY FOR HEALTH CARE ADMINISTRATION

LIFE CARE CENTERS OF OF AMERICA, INC.

DATED:

I .

'

q /) q,/1/

.

s, Esquire

Flo i arNo.: 341819 Cathy M. Sellers

Florida Bar No.: 784958 Broad and Cassel

Sun Trust Bank Building

215 South Monroe Street, Suite 400

Tallahassee, Florida 32301 Representing each Life Care Facility.

_

William H. Roberts Acting General Counsel

Agency for Health Care Administration 2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5407

LJr\.i .L,LJ.

4d/!

R1, ar ph 1ba, Esquire Assistant General Counsel Florida Bar No.: 0240389

DATED:

2727 Mahan;riL,Bu{lding 3, MS 3

Docket for Case No: 09-001383

Orders for Case No: 09-001383