Apr 1? 2009 15:05 APR-17-2889 16:18 AGENCY HEALTH CARE ADMIN 856 921 @158 P2829 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION - STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2009000372 New Port Richey Medical Investors, LLC d/b/a Life Care Center of New Port Richey Respondent, / ADMINISTRATIVE COMPLAINT Petitioner, the Florida Agency for Health Care Administration (“4HCd”), through undersigned counsel, files this Administrative Complaint against the above-named Respondent (“Respondent”) pursuant to Sections 120.569 and 120.57. Flotida Statutes (20079), and alleges: NATURE OF THE ACTION lL. This is an action to impose an administrative fine in the amount of Sixteen Thousand Six Hundred Forty Four Dollars ($16,644.00) (the “fine amount”) against Respondent, pursuant to Section 408.040, Florida Statutes, and Florida Administrative Code Rule 59C-1.021. "Unless otherwise noted, all statutes and rules hereinafter cited are to the indicated year’s version of the statute or rule because this is the controlling year in question. Page 1 of 9 APR-17-2889 Apr 1? 2009 15:06 16:18 AGENCY HEALTH CARE ADMIN 856 921 @158 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. P.2iv2g 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: 10. 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 in 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 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 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 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 accoum. § mitigation the degree of noncompliance. Proceeds of such penalties shal] be deposited in the Public Medicaid Assistance Trust Fund. xk 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) Genera] Provisions. The agency shall initiate administrative proceedings for revacation 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 mR Page 3 of 9 Apr 1? 2009 15:06 APR-17-2889 16:19 AGENCY HEALTH CARE ADMIN 856 921 @158 P2229 (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 tomes 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 comes first. The schedule of fines is as follows: (a) 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 penally the agency shall take into account the degree of noncompliance. (b) 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 after the date of receipt of the notification of assessment or 2] calendar days after final agency action. The final balance wil] 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. 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 11 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 atiached 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 JS 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. Page 4 of 9 Apr 1? 2009 15:06 APR-17-2889 16:19 AGENCY HEALTH CARE ADMIN 856 921 @158 P.23/29 Submitted as of the date indicated on the below Certificate of Service, Agency for Health Care Administration A G SG. v Richard Joseph Saliba, Esquire Senior Attomey 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 THEREBY 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, Flotida 34653 on this AGH, day of February 2009. Agency for Health Care Administration ae . * I 4 Ch 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 Page 5 of9 Apr i? 2009 15:07 APR-17-2089 16:19 AGENCY HEALTH CARE ADMIN 856 921 4158 P2429 EXHIBITS (AHCA v. Life Care Center of New Port Richey Case No.2009000372) EXHIBIT “A”— — Respondent’s CON # 8813, requiring a minimum of 25.50% of the 113 bed facility’s total annual patient days shall be provided to Medicaid patients. EXHIBIT “8” - Florida Nursing Home Utilization Report for Year 2007, page 80. EXHIBIT “C” — Respondent's facility report for calendar year 2007. (All are copies) Page 9 of 9 Apr i? 2009 15:07 17-2005 ePR- =z zE Ts lu ira cam La) a He ram ii Lt 2s 5 iu [ia] L STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CERTIFICATE OF NEED Under the provisions of the “Health Facility and Services Development Act” (Sections 408 031-.045, Florida Statutes (Supp 1992), AND Chapter 59C-1, Blorida Administrative Code}, the Agency for Heaith Care Administration certifies the need for this project. *Atoended by transfer via COM #9355 ; “Condition Modification (3/14/08) APPLICANT: : NUMBER: 8813 *Life Care Health Resources, Inc. : PROJECT COST. $5,043,022 3570 Keith Street, NW ISSUE DATE: May 4, 1998 Cleveland, Tennessee 37312 TERMINATION DATE: May 3, 1999 REVISED TERMINATION DATE: COUNTY: Pasco DISTRICT: 5 oo SUBDISTRICT: 1 PROJECT DESCRIPTION: Construct and replace a 56-bed facility, Whispering Pines Nursing Center. “The beds will be added to CON #8496 to create a 113-bed community nursing home. This project involves 33,000 GSE of new construction and $2,811,900 in constuction costs. - CONDITIONS: *(1) A minimum, of **25.5 percent of the 113-hed facility's total annual patient days shall be provided to Medicaid patients; (2) A 30-bed Alzheimer’s unit shall be created; and (3) A research grant for $10,000 shall be provided to the school of nursing at Florida. A & M University: : FORM 1793, APRIL 1993 J Apr 1? 2009 15:08 DISTRICT 5 NURSING ROME UTELIZATION al Ganuary 2087 - December 2007 Data} © wi . . n ~ BED DAYS : ANNUAL TOTALS a QUARTERLY TOTALS 01/07-1207 JANUARY 1, 2007 - DECEMBER 31, 2007 fia] Licensed Beds JAN- APR. G-ALO. JUL- OCT- 6-2O. BED PATIENT TOTAL M'CAID M'CAID = 5. Facility Mame ‘Total Comm. Shel.| MAR JUN TOTAL SEP DEC TOTAL| BAYS DAYS OCCUR BAYS OCCUP Pt Aburict a Comety ral 2 ‘aldomero Lopez Memorial Veterans NH. (Excluded) 120 a q an Eayonet Pom Health & Rehabilitation Center 180 180 Oo} 16200 16564] 45700 S7627 9 877154 223 S2.4S% Gear Creck Nursing Cenier 120 120 oO} 10a00 11040 43800 41640 95.0794 18857) 45.29% Onnsulale Health Care of Bayonel Point 120 120 OF} it8oo 11040 43800 39754 0.76% 18163 45.69% Consulate Health Care of New Port Richey y20 120 OF 20dc0 liga 43800 41901 95.66% 26484 63-21%, Firaréland of Zephyrinills 120 120 Oo; Load ~ J 104g 41e00 41130 93.90% 27395 67 164] 4 Teather Hill Healthcare Center 120 120 Oo} 1800 11040 43800 41089 = 81% 28845 70.2054: 8 Heritage Parle 126 120 OF biaon 11040) 43800 942140 96.21% 245 65.6058 ‘4 Life Care Center of New Port Richey 143 113 Oo} 3n70 10396 41245 38300 = 92.86% 7906 20.64% 4 ‘Madison Pomte Rehabiliation and Nutsimg Center 19 419 Oo) 1dvio 10948 43435 41465 95 d6% 25049 62.86% 8 chard Ridge Rehabililation and Nursing Cemer 120 120 Go) 10800 11040 43800 42053 96-01% 18603 64.24% z ‘o Pasco Nursing and Rehab Center (Closed 12/1 0401} . = iB] Rayal Gak Nursing Center 126 120 OF Woo = 10970 11040 43800 37972 86.60%, 26lES 68.96% =I 4 sulbent Pines Healthcare Center : 120 120) Oo] Leseo 8610920 11040 49800 32257) 73.65% 22029 66 25%] #1 “SSuspering Pines Nursing Center (Closed 2/15/03} W ia Hodson Woods Rehabililation and Healthcare Center 103 103 q 9270 5476 34774 92 4986 20119 57.8634) 5 HA Seplaye Haven Health & Rehab Center, Inc. 120 120 a 10800 8=10020 11040 39763 78 26344 66.25% rH Zephyrhills Health & Rebab Center, Inc 1o3 103 a 270 9373 9476 34811 92 59% 19863 57.06% a, + an Abbey Rehabilitation and Mursing Center 4 Advanced Rehabilitation and Health Center i6 fJhambra Health and Rehabilitation Center Hegro at Callege Harbor, The ig Alame Health & Rehabilitation Cemer ‘] Apollo Health & Rehabililation Center Hoy Pointe Nursing Pawition Bay Tree Rebailalalion and Nursing Center Payside Rehabilitation & Health Center “4 Maywood Nuising Center 2 Belleair East Health Care Center 3 Roaca Ciega Center rad a 16 a3 APR-17-2889 420 20 120 120 120 osoprposocococanca 80 35480 43800 21500 18980 20865 43800 43300 43800 33580 38052 42389 19399 16931 17832 39399 aoiza 41028 31580 19493 4ts20 3878! 6H 55% 30.78% BB S74 8o.20% BS.73%6 $9 93% 92.05% 9D.67%M 94.04% 90.52% 34.34% 88 54% 3282 3122 5506 S602 14489 26871 T1I55 25359 24182 18768 25865 27683 o2 250% F655: $0 92% 34.09%, EL 25% 68.22% TESS TE Sa 76 S7% 95 28% 62 60% 71.38% AACA M0408 Pi2ar/eg Life Care Centers of America Southeast Division Apr 1? 2009 15:09 fal CON Fledicaid Condilion Compliance 2007 ra . 7 36 of Traditionat AFB+C | % ol Facuionat i ; Bt con A | atten | B | A* B |itescaitoars |e Vac rwcn | hesccartns nee | 2! Medicaid Tora ears Requianven tg | Traviuonal | io Total Medicaid | fragitionst plas Wenicaid Medicare A plus, Hospice | MER wrnCD. _ are vatence ts f A Conditions Medicaid Days Kospice |" free ot tat Dave ‘e ee Medicaid plus, | Cois.Daysto | "8°" | condivon | Days Booked Days Daye Baaked Insurance MCRA Bays we | Total Days H MCO Coins. Booked ? im : i 45.64%, 38,242 47,454 11,533 30.45% 530 12413 87s] 3,028 45141 20.50% 2.513 LI they $7,449 . 23S Ba 725 47.04% ayid 75,689; 49.94% . 2,152 341 5l.6B% 13,606 TH.Ob, 39,296 7,859 11,672! 79.5550 2434 14943 15.74% 2704 16,837 42455! 3,97 FI 5000 38,740 15,370 23,064 55.54% 2,323 25,007 BB a 4,79 30 466 TALBA%G, 11,0396 000%! 38,927 11,97 6 14,045 35.78% 2a12 16,457 41 22% 4,579) 21,016 §2.69%5 ase ABA 40,898 18,984 6.588 18.11% a4 5,382| 17.40% 4,264 8236: 20.14% “10,745 : 45.00% aa7a6| 17,904 15,297 38.45%: 2031] 47,388 4a. 1903 19,297 48.50% 4,391 = : 25 5054 Sao. 9,742! 7,729 20.25 235 Toba 70 85% 3,027 10,991 BETTS 1,249 a 20.0% 40,028 11,852 10,199 26.35% 9a 11,457 28.08% 3,942 45,399] aTIT% gat we 62,138 33,275] a T4a daesul 3,108 30,849 AD. B5% 5,330 16,179 58.22% 2,904 5 39,744] 12,396 $602 14.10% ars anit 16.90% 1224 9,937 25.0054 459 = 47,478 48,298 19,174 A1.G5% 54 20,368] 42.89% 1,887 22,282 AB ATG 5954 a J 20,780 71,063 4621 46.03%: o 4621 15 01% 2.468 7.069 23.05% asgta) oo ' fier Ww 39,930 18,767 12,602 31.56% 3,020 15,822 912% ata 17,736 44.42% “oat > F 55,422 31,036] 56.06% z9Z4 35,994 Basa 2,510 36,504 65.an% seal z 2 43644 39,046 413,416 31.084) 739 2,999 33.1454) 5,164 414,103 36.12% 687 oi 50.4358 40,455 20,362! 7.58% 1,674 20,928 51.73% 3,285] 24,213 s9.a5% 3,851 51.5194 61,157 31,802 45.57% 4,808 29,922 48 93% 5,135 38,057 a7 32% 2,585, rai 16 APR-1'7-2889 Jd thach ment Apr 1? 2009 15:09 APR-17?-2889 16:22 AGENCY HEALTH CARE ADMIN 854 921 @158 P2829 Ba eosin sevice. Home| Hl | lan Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 6527 2449 ea emer Status: Delivered Track & Confirm “OH pc Enter Label/Receipt Number. Your item was delivered at 12:07 PM on Fabruary 28, 2009 in NEW Eee PORT RICHEY, FL 34653. Notification Options - Track & Confirm by email Get current avent information or updates for your itam sent ta you or others by amail. ( fa. f Sile Man Ganlact Wa Forms Gayl Rerviees HORS Palvacy. Falloy Terma.of Waa National’ Premier Accounts Copyright® 1999-2007 USPS, All Rights Reserved. No FEAR Act EEO Data FOI, e : http://trkenfrm 1 .smi.usps.com/PTSInternet Web/InterLabellnquiry.do 3/26/2009 Apr 1? 2009 15:09 APR-17?-2889 16:22 AGENCY HEALTH CARE ADMIN 856 921 4158 P.29/29 SENDER: COMPLET. COMPLETE THIS SEC IHON ON DELIVERY HIS SECTION @ Complete items 1, 2, and 3, Also complete Item 4 if Restricted Delivery is desired. F @ Print your name and address on the reverse fs is L] Addressee 80 that We can return the card to you. rd of Det @ Attach this card to the back of the mallpleca, . ©. Date wer or on the front if space permits. Lite Care Canter of New Port Rich Prken: damien, Sr rotor M407 Teouisle Creek Rot Naw Pore Rickey FL ENE addrens, D. Is delivery ans a a QO Return : Raceipt for Merchandise C1 Insured Malt O Gop. 4, Reatricted Delivery? (Extra Fea) 2. Article Number : (Transter from service label) 7OO4 2890 gO00 SS5e? 2444 PS Form 3811, February 2004 Domestic Retum Receipt 102596-08-N-1EHO | TOTAL P.2o

Docket for Case No: 09-002074