[0-H FILED oe ANCA - AGENCY CLERK STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 200 KAY 20 A 8 13 STATE OF FLORIDA, AGENCY FOR HEALTH CARE - Tt ADMINISTRATION, » a Petitioner, 2 wo Ft ; “ - ne) co vs. MPI reference No.: CI 10-1244800 °° 3 Provider No: 8853177 00 pe , License No.: RT0007212 bad STEPHANIE L. NICHOLS © Respondent. . / FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. . In a letter dated March 1 2010, Stephanie L. Nichols (Respondent) was informed that the State of Florida, Agency for Health Care Administration (Agency) applied a sanction of termination from participation in the Florida Medicaid program pursuant to Rule 59G-9.070, Florida Administrative Code. Pursuant to Section 409.913(6), Florida Statutes, the letter was sent to the Respondent at the address last shown on the ptovider enrollment file. The letter was refused. The letter contained full disclosure and notice regarding the Respondent’s administrative hearing and due process rights. To date, the Respondent has not requested a hearing to dispute the facts contained in the letter; and, the timeframe within which Respondent had to request a hearing has expired. FINDINGS OF FACTS 1. The letter was sent to the Respondent at the address last shown on the provider ~ enrollment file that applied a sanction of termination from participation in the Florida Medicaid | program pursuant to Rule 59G-9.070, Florida Administrative Code. The letter was refused. 2. The letter disclosed-the Respondent’s administrative and due process rights. 3. The Respondent has not disputed imposition of the sanction as set forth in the letter. CONCLUSIONS OF LAW | 4. The Agency incorporated. ‘and adopts the statements and conclusions of law as set forth in the aforementioned letter . 5. The sanction as set forth in the letter is final.- - BASED on ‘the foregoing, it is ORDERED and ADJUDGED that the Respondent is terminated from patticipation in the Florida Medicaid program pursuant to Rule 59G-9.070, Florida Administrative Code. . bh ~ DONE AND ORDERED this | 4 day of MAY, 2010, in Tallahassee, Florida. Thomas W. Arnold, Secretary 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 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 RENDITION OF THE ORDER TO BE REVIEWED. are : Copies furnished to: _ Stephanie L. Nichols 9908 Gulf Drive Anna Maria, Florida 34216 (U.S. mail, certified) ; D. Kenneth Yon, Bureau Chief Medicaid Program Integrity (Interoffice mail) Finance & Accounting Cnteroffice mail) Shawn McCauley Medicaid Contract Management (via email only) DOH License No.: RTO0072 12 (via email only) CERTIFICATE OF SERVICE. I HEREBY CERTIFY that a true and correct copy of the foregoing has been ee on the above-named persons by U.S. Mail or interoffice mail as indi: on this the mes day of ; Richard Shoop, Agency Clerk «State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 | (850) 922-5873 ‘(Page 1 of 3) FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION, CHARLIE CRIST THOMAS W. ARNOLD ollie esr ce een cactachtetin, —. THOMARWTARNou GOVERNOR Better Health Care for all Floridians = SECRETARY CERTIFIED MAIL NO.7004 2510 6001 4446 0921 Date: March 1, 2010 Stephanie L. Nichols 9908 Gulf Drive Anna Maria, Florida 34216 Provider No: 8853177 00 In Reply Refer to: Termination from participation Dear Ms. Nichols: Our records indicate you were convicted on September 25, 2007 with Medicaid fraud and Organized fraud. In accordance with Sections 409.913, Florida Statute (F.S.), and Rule 59G-9.070, Florida Administrative Code (F.A.C.), the Agency for Health Care Administration (Agency) is hereby terminating your participation in the Medicaid program (7L).. This includes any action that results ina claim for payment to the Medicaid program as a result of furnishing, supervising a person who is furnishing, or causing a person to furnish goods or services. : You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. If a request for a formal hearing is made, the petition must be made in compliance with Section 28-106.201, FAC. and mediation may be available. If a request for an informal hearing is made, the petition must be made in compliance with rule Section 28-106.301, F.A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this letter. For more information regarding your hearing and mediation rights, please see the attached Notice of Administrative Hearing and Mediation Rights. : - Any questions you may have about this matter should be directed to: Horace Dozier, Field Office Manager, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan uo Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 921-1802, facsimile (850) 410- 1972. . : ; Sincerely, Horace Dozier Field Office Manager. ~ Office of Inspector General Medicaid Program Integrity ce: Kim Kellum, Chief Medicaid Counsel Jim Hampton, Division of Medicaid DOH(via email only) : ne Visit AHCA online at 2727 Mahan Drive, MS# 6 http:ahca.myflorida.com Tallahassee, Florida 32308 (Page 2 of 3} Stephanie L. Nichols Provider No: 885317700 © Page 2 of 3 - NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS ° You have the right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Audit Report (hereinafter FAR), you may request a formal administrative hearing pursuant to Section 120.57(1), Florida Statutes. If you do not dispute the facts stated in the FAR, but believe there are additional reasons to grant the relief you seek, you may request an informa! administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section 120.573, Florida Statutes, mediation may be available if you have chosen a formal administrative hearing, as discussed more fully below. ; ‘The written request for an administrative hearing must conform to the requirements of either Rule 28-106.201(2) or Rule 28-106.301(2), Florida Administrative Code, and must be received by the Ageacy for Health Care Administration by 5:00 P.M. no later than 21 days after you received the FAR. The address for filing the written request for an administrative hearing is: ; a Richard J. Shoop, Esquire Agency Clerk . _- Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Fax: (850) 921-0158 ‘The request must be legible, on 8 % by 11-inch white paper, and contain: 1. Your name, address, telephone number, any Agency identifying number on the FAR, if known, and name, address, and telephone number of your representative, if any; . 2. Anexplanation of how your substantial interests will be affected by the action described in the FAR; | ; 3. A statement of when and how you received the FAR; 4. Fora request for formal hearing, a statement of all disputed issues of material fact; 5. Fora request for formal hearing, a concise statement of the ultimate facts alleged, as well as the tules and statutes which entitle you to relief; 6. Fora request for formal hearing, whether you request mediation, if it is available; 7. Fora request fot informal hearing, what bases support an adjustment to the amount owed to the . ‘Agency; and . 8. A demand for relief. * A formal hearing will be held if there are disputed issues of material fact. Additionally, mediation _ may be available in conjunction with a formal hearing. “Mediation is a way to use a neutral third party to assist the parties in a legal or administrative proceeding to reach a settlement of their case. If you and the - Agency agree to mediation, it does not mean that you give up the right to a hearing. Rather, you and the Agency will try to settle your case first with mediation. If you request mediation, and the Agency agrees to it, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement. If a mediation agreement is not reached within 10 days following the request for mediation, the matter will proceed without mediation. The mediation must be concluded within 60 days of having entered into the agreement, unless you and the Agency agree to a different time period. The mediation agreement between you and the Agency will include provisions for selecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shared equally by you and the Agency. o _ (Page 3 of 3) Stephanie L. Nichols Provider No: 8853177 00 Page 3 of 3 Ifa written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set _ path ip ts. 4H8 alia Be, candusive, aab Fatt crant to Chapter 120, Florida Statutes, and the action set: forth in the FAR shall be conclusive and final. cs on 7004 2530 D012 4446 0922. Fa Stephanie L. Nichols AN fone 9908 Gulf Drive foe: ‘gt “gs ll Florida 4216 Bok ao ss — ee : - , y* ‘ga Lhe. £ $ om = a m . . F=4 o NIXTE 337 DE. C0 OS/iazio i : . RETURN TO SENDER _ REFUSED . UNABLE TCO FORWARD BC: S290e5K8C727 *O638-03825-03-38 SA21 Eee Srgbeor Inlaablaldbalsebdbsleslisbulashlonlbbal = 5 E ipnciatci ia a a 8). {it 40 tbe SHY! ‘24 i afts [9 Oxcess:or possess any drugs or narecti¢s “5 less prescribed by a SY vhcie intoxicants, drugs, or other dangerois substances are — -advise your emiployer.of afjon statu, and j, as directed: by. your officer. °"-: ; the Court oritie officer, and ‘and you will comply “- gurisdicti ict jon Bs to festivition and investigative fee, bath to be:paid as condition of the Probation Office with money, swrcharge will be assessed. The faa search our ste] DOH Home | A-ZTopics { AboutDOH | SiteMap | ‘Contact Us” floridashealth.com TEPHANIE LYNN NICHOLS ; ICENSE NUMBER: RT7212 _ Printer Friendly Version Ed REGISTERED RESPIRATORY THERAPIST CLEAR/ACTIVE G 03/27/2003 1001 26TH AVE WEST BRADENTON, FL 34205

Docket for Case No: 10-009654