STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

FILED

AHCA

AGENCY CLERK

ZOIO JUN I W A 8: 25 ·

Petitioner,

vs.

CONCHITA JACKSON, M.D.,

Respondent.

CASE NO. 10-0417MPI Audit No.: 10-1058-200

Provider No.: 271096000 Fla. License ME91449

/

FINAL ORDER

THIS CAUSE is before me for issuance of a Final Order. In a letter dated December 28, 2009, Conchita Jackson, M.D. (Respondent) was informed that the State of Florida, Agency for Health Care Administration (Agency) was seeking a $500.00 fine for violation of Rule 59G-9.070 (7)(e), F.A.C.

On January 21, 2010, the Respondent requested a Formal Administrative Hearing. The request was forwarded to the Division of Administrative Hearings ("DOAH") on January 27, 2010, by the Agency and assigned to an Administrative Law Judge ("ALJ").

On April 30, 2010, the Respondent withdrew the hearing request and agreed to pay the $500.00 fine.

On May 3, 2010, the ALJ issued an Order Closing File based on the Respondent's correspondence dated April 30, 2010, withdrawing her hearing request.

ORDER

Filed June 15, 2010 9:50 AM Division of Administrative Hearings.

BASED on the forgoing, it is ORDERED and ADJUDGED that Respondent submit payment in form of a certified check in the amount of $500.00 in accordance with Section 409.913, Florida Statutes, and Rule 59G-9.070, Florida Administrative Code.

Respondent shall make payment in full within 30 days of the rendition of this

final order.

DONE and ORDERED this lf J... day of      

J        ,2010, in Tallahassee,

Florida.

,/J '

JL.• /1. '

[&

Thonias W. Arnold, Secretarr: Agency for Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, 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.

Copies furnished to:

June C. McKinney Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

Conchita Jackson, M.D. 881 East 2nd Avenue Hialeah, Florida 33010

Karen Dexter

Assistant General Counsel

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

Tallahassee, Florida 32308 (Laserfiche)

Horace Dozier

Field Office Manager

Office oflnspector General, Medical Program Integrity (Interoffice mail)

Finance & Accounting (Interoffice mail)

Health Quality Assurance (E-Mail)

Department of Health (E-mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been served on the above-named persons by Electronic Mail or Laserfiche as indicated on this

theL of ,            ,2010.

Richard Shoop, Agency Clerk State of Florida

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

Tallahassee, Florida 32308-5403

(850) 922-5873

Docket for Case No: 10-000417MPI

Orders for Case No: 10-000417MPI