STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION 2014 NOV - 3 P 12: 3 I

DOS OF HIALEAH, LLC d/b/a HIALEAH SHORES NURSING & REHAB CENTER,

vs.

Petitioner,

PROVIDER No: 250988 ENGAGEMENT No.: NH07-068J

RENDITION NO.: AHCA- i - oiq3 -S-MDA

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

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FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the

foregoing, this file is CLOSED.

DONE and ORDERED on this the _,,sl

day of ,,0,e:...,:1c6:c:.... -=-o=:....,U=----' 2014, m

Tallahassee, Florida.

ELIZ , SECRETARY

Agency for Health Care Administration

AP ARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF ARCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BYLAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE AP ARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

Theodore E. Mack 3700 Bellwood Dr.,

Tallahassee, FL 32303

Bureau of Health Quality Assurance 2727 Mahan Drive, Mail Station 9

Tallahassee, Florida 32308 (Interoffice Mail)

Stuart Williams, General Counsel Agency for Health Care Administration 2727 Mahan Drive

Building 3, Mail Station 3

Tallahassee, Florida 32308 (Interoffice Mail)

Shena Grantham, Chief Medicaid FFS Counsel

Agency for Health Care Administration 2727 Mahan Drive

Building 3, Mail Station 3

Tallahassee, Florida 32308 (Interoffice Mail)

Karen Chang, Bureau Chief Medicaid Program Analysis 2727 Mahan Drive

Building 2, Mail Station 21

Tallahassee, Florida 32308 (Interoffice Mail)

Agency for Health Care Administration Bureau of Finance and Accounting 2727 Mahan Drive

Building 2, Mail Station 14

Tallahassee, Florida 32308 (Interoffice Mail)

Zainab Day, Medicaid Audit Services Agency for Health Care Administration 2727 Mahan Drive, Mail Station 21

Tallahassee, Florida 32308 (Interoffice Mail)

Kristin M. Bigham

Office of the Attorney General The Capitol PL - 01 Tallahassee, FL 32399-1050 (Via US Mail)

State of Florida, Division of Administrative Hearings

The Desoto Building 1230 Apalachee Parkway

Tallahassee, Florida 32399-3060 (Via U.S. Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this theof 14.

- ?

Richard J. Shoop, Esqmre Agency Clerk

State of Florida

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

Tallahassee, Florida 32308-5403

Docket for Case No: 09-005320

Orders for Case No: 09-005320