Sep 10 2009 15:10 ag/le/28e9 15:86 8589218158 PAGE STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2009007382 Return Receipt Requested: v. 7009 0080 0000 0586 7499 7009 0080 0000 0586 7505 FLORIDA HOME BOUND, MENTAL HEALTH AGENCY, INC. d/b/a FLORIDA HOME BOUND, MENTAL HEALTH AGENCY, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (“AHCA”’), by and through the undersigned counsel, and files this administrative complaint against Florida Home Bound, Mental Health Agency, Ine. d/b/a Florida Home Bound, Mental Health Agency, Inc. (hereinafter “Florida Home Bound Mental Health Agency, Inc.” or the “Parent Agency”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2008), and herein. alleges; NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $40,000.00 pursuant to Section 400.74(4), Florida. Statutes (2008), for the protection of public health, safety and welfare. arly Sep 10 2009 15:10 ag/le/28e9 15:86 8589218158 PAGE 8/17 _ JURISDICTION AND VENUE 2. AHCA has Jurisdiction pursuant to Chapter 400, Part Tit, Fiorida Statutes (2008). 3. Venue lies pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 4, ABCA is the regulatory authority responsible. for licensure and enforcement of all applicable statutes and rules governing home health agencies,. pursuant to Chapter 400, Part ITI, Florida Statutes (2008), and Chapter 593-8 Florida Administrative Code. 5. Florida Home Bound, Mental Health Agency, Inc. operates a home health agency located at 1400 MN, E. 125° Street, North Miami, Florida 33161. Florida Home Bound, Mental Health Agency, Inc. is licensed as a home health agency under license number 299991076. Florida Home Bound, Mental Health Agency, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required te comply with all applicable rules and statutes. Sep 10 2009 15:10 ag/le/28e9 15:86 8589218158 PAGE 9/17 COUNT I FLORIDA HOME BOUND, MENTAL HEALTH AGENCY, INC. DEMONSTRATED A PATTERN OF BILLING A PAYOR FOR SERVICES NOT PROVIDED. SECTION 400.474(4), FLORIDA STATUTES (FRAUDULENT PATIENT RECORDS STANDARDS) UNCLASSIFIED DEFICIENCY 6. AHCA re-alleges and incorporates Paragraphs (1) through (5) as if fully set forth herein. 7. Florida Home Bound, Mental Health Agency, Ince. was cited with two (2) deficiencies as a result of a complaint investigation survey conducted on April 3, 2009. 8. ‘A complaint investigation survey was conducted on April 3, 2009. Based on record review and interview, it was determined that the Home Health Agency demonstrated a pattern of billing a Payor (CMS) for services not provided by the home health agency for 8 of 8 sampled patients. Services provided by either a branch or subunit where a branch or subunit is not a part of an approved HHA or where the branch or subunit has not been determined to meet the applicable CoP's are not to be submitted to CMS for payment. The findings include the following. | 9, Record Review conducted on 03/31/09 of the findings of the licensure survey conducted on 2/25/09 at the non-parent location revealed that a Home Health Agency license was issued Sep 10 2009 15:11 69/16/2889 15:46 85892148158 PAGE 18/17 under the corporate name of the parent HHA (Florida Home Bound and was authorized to operate effective 10/29/07 to 10/28/03 in Broward County only. The location ig in a different geographic service area from the parent HHA which is located in Dade County. 10. Based on the definition of CMS, a Branch office is a location ox site from which a HHA provides services within a portion of the total geographic location served by the parent agency, and a Subunit serves patients in a geographic area different from that of the parent agency and must independently meet the HHA Condition of Participation (CoP's). The non~-parent jocation meets the definition of a Subunit. 11. Review of the Provider Survey Profile listed on CASPER Report 0401D with a run date of 03/09/2009 and with the Last Update of 03/0//2009 revealed that the parent HHA indicated "No" for questions in reference to the operation of Subunit(s) of Branch (es). 12. Communication with AHCA’s Home Health Unit, the scction of the Agency which handles licensing of home. health agencies, revealed that the Subunit at the Broward location has never been identified te AHCA or to CMS, either as a branch or subunit of the parent HHA and that there was no notification received from the parent HHA to add a non-parent location. Sep 10 2009 15:11 ag/le/28e9 15:86 8589218158 PAGE 11/17 13. State Operations Manual (SOM) Chapter 2 The Certification Process for HHA Section 2182.4 states that CMS approval is necessary for a Non-Parent Location. This section further stated that "As part. of the provider certification process, an existing Médicare-approved HHA must provide notification to CMS through the State Agency (AHCA) of its proposal to add a non parent location. 14, Survey report of the Subunit located in Broward also revealed that the all patient's clinical records were kept and maintained in the main office at. the parent HHA in Dade county, and not in the Subunit located in Broward. All the active patient records were requested by AHCA personnel and were brought to the Subunit in Broward. 15. Review of all 8 of 8 clinical records, all noted to be Broward County residents, revealed documentation of activities consistent with a HHA with Medicare/Medicaid certification (OASIS (Outcome and Assessment Information Set) submission, plans of treatment containing HIC (Health Insurance Claim— Medicare beneficiary) numbers, consents for treatment, verification of Medicare coverage and a financial agreement that was blank for payor sources.) a. SPe1 - Start of Care (S00) 07/03/08, Certification Date: -12/30/08 - 2/27/09 Diagnosis: Heart Disease Poc - SN & Home Health Aide{hha) County of Residence: Broward. Sep 10 2009 15:11 ag/le/28e9 15:86 8589218158 PAGE 12/17 b. SP#2 - SOC: 10/30/08 Certification Date: 12/29/08 ~2/26/09. Diagnosis: FX Decline, IDDM POC - SN 1060, hha 2X1 County of Residence: Broward. c. SP#3 $0C; 10/15/07 Certification Date: 02/06/09 - 04/06/09 Diagnosis: IDDM, Polyneuropathy FOC: SN 1 day 60, LCSW. d. SP#4 S0C: 10/17/07 Certification Date: 12/10/09 - 02/7/09 Diagnosis: Post Gastrostomy/Trach FOC: SN, hha, and LCSW. County of Residence: Broward. e. SP#5 SOC: 08/14/06 Certification Date: 01/20/09 - 03/20/09 Diagnosis: Heart Disease, HTN Poc - SN, hha County of Residence: Broward. f. SP#6 SOC: 03/26/08 Certification Date: 01/20/03- 03/20/09 Diagnosis: Heart Disease PoC: SN, hha, County of Residence: Broward. g. SP#7 SOC: 09/03/2008 Certification Date: 01/01/09 ~ 03/01/09 Diagnosis: IDDM PoC: SN, PT County of Residence: Broward. h. SP#8 SOC; 06/14/07 Certification Date: 12/05/08 - 02/02/09 Diagnosis: unknown POC: SN County of Residence: Broward. 16, Review of the non-parent survey report showed that during an inlerview with the Administrator and two staff mombers conducted on 02/25/09 at approximately 11:00 AM, it was revealed that the Home Health Agency has a current census of 7 patients who reside in the county where | the Home Health Agency is licensed. The Administrator further reported that all the patients were receiving skilled services and the patients are Medicare patients receiving services from the Home Health Agency under Madicare guidelines. Sep 10 2009 15:11 69/16/2889 15:46 85892148158 PAGE 13/17 17. He further reported that the Home Health Agency's Parent office is a separately Licensed Home Health Agency located in an adjacent county, but different geographic area, and that the parent Home Health Agency is a (Medicare/Medicaid) certified agency. He continued to report and the staff members agreed, during, the interview on 02/25/09 at approximately 11:00 AM, that the billing for the Broward County home health agency is done from the parent HHA location in Dade county using the provider number assigned to that location. 18. The billing manager at the parent office was contacted by telephone at approximately 11:15 AM on 02/25/09, and confirmed during the phone interview that that the parent Home Health Agency was using the Medicare provider number assigned to the parent office to bill Medicare for the patients served by the non-parent HHA (subunit) located in Broward county. This subunit is separatély licensed but not a Certified Home Health Agency. The License for this non-parent Home Health Agency was requested, reviewed and confirmed that it was licensed only, but not Certified. 19. Section 2182.4¢ of the SOM for HHA states that "A provider may not bill Medicare for services provided by either a branch or subunit where a branch or subunit is not a part of an approved HHA or where the branch or subunit has not been determined to meet the applicable CoP's. Sep 10 2009 15:12 ag/le/28e9 15:86 8589218158 PAGE 14/17 20. Based on the foregoing facts, Plorida Homa Bound, Mental Health Agency, Inc. violated Section 406.474(4), Florida Statutes, which warrants an assessed fine of $40,000.00 ($5,000.00 x 8 patients/incidents that were billed]. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Florida Home Bound, Mental Health Agency, Inc. on Count I. 2. Assess against Florida Home Bound, Mental Health Agency, Inc. an administrative fine of ¢40,000.00 on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the court deems is just and proper on Count I. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Sep 10 2009 15:12 ag/le/28e9 15:86 8589218158 PAGE 15/17 Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Alba M. Rodriguez, Ese Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52: Terrace - #103 Miami, Florida 33166 Olba: im. & edeeguts Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Sep 10 2009 15:12 ag/le/28e9 15:86 8589218158 PAGE Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Home Health Agency Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of, the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Odette McBride, Administrator, Florida Home Bound, Mental. Health Agency, Inc., 1400 N. E. 125th Street, North Miami, Florida 33161; Carol Biggs Owens, Registered Agent, 7310 Belle Meade Island Drive, Miami, Florida 33138 on this pe day of August, 2009. oe Teme Bodasg x 16/17 Sep 10 2009 15:12 9/14/2889 8589218158 15: 86 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY PAGE 17/17 FF, Home Bletuelt amb! Cesta MAB WE 125 Sit ont Minkh Heme. Fdertder 33ibp (Endorsement Required) rf a = Complete items 1, 2, and 3. Also complete a item 4 it Restricted Delivery Is desired. @ Print your name and address on the reverse at § 4 i. 80 that wa can return the card to you. et “Ty @ Attach this card te the back of the mallpiece, o or on the front if space permits. rm Certified Fes 1. Article Addressed te: o a] iat fy Ensen eta Qdutte He Bade Po Reaincted Delivery Fre so fl a r fa] a rE 4. 7009 0080 oO00 N58 7494 . 18 delivery adcresa differant from item 17 C1 Yes YES, enter delivery address below: | i ONo (Transtar trom service label) | PS Form 3811, February 2004 ' SENDER: COMPLETE THIS SECTION i lete leta items 1, 2, and 3. Also comp! ila * hom "4 \f Restricted Delivery Is desired. Domestic Return Pacaipt (a) hin Con pa A. Signature pr Xfaore » Service Type © Certified Mail 1 Express Mail O Regleterad OD Return Receipt for Merchandise C3 insured Mail O cop, Restricted Delivery? (Extra Fee) . DI Yes Daath +382 102596-02-M-1540 ’ o Agent SASL Pibor delivery infornidtion vicit culm OFFIC Print your name and addrass on the reverse go that we can raturn the card to you. secs : i@ Attach this card to the back of the mailpiece, B. Received Wey gen POE AA se (Printed Name} G. Date of Dalivary B-Zp-J or on the front ff space permits. Tein Potts dead Solon Doe Postage | ¢ i ‘Cortified Fae tum Receipt Fee (Endotement Required) Restristes Dallvery Fae D. is delivery address diffarent from inv YES, enter delivery address below: 7009 O08 OOO0 psa 7505 goa O08 PS F mm 3811, February 2004 Domestic Return Receipt “ . . . en s (Endorsement Fiiqutread) amt. © ame 5ish — : Ci Certified Mail = (11 Express Mall njerehancice CO Registered (O Return Receipt for Met Oiinsured Mai) GO. ‘2. Rechigtad Dellvery? (Extra Faa) Ol ves 4 THA g pood 0586 740 PB. ta Cam pt 102805-02-M-1540

Docket for Case No: 09-004939