STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2010013529 v. Return Receipt Requested: 7009 0080 0000 0586 3835 SWAN HOME CARE SERVICES, INC. d/b/a SWAN HOME CARE SERVICES, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Swan Home Care Services, Inc. d/b/a Swan Home Care Services, Inc. (hereinafter “Swan Home Care Services, Inc.”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2010), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $15,000.00 pursuant to Section 400.474, Florida Statutes (2010), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2010). Filed February 9, 2011 4:23 PM Division of Administrative Hearings 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing home health agencies, pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 59A-8 Florida Administrative Code. 5. Swan Home Care Services, Inc. operates a home health agency, located at 2500 Quantum Lakes Drive, Suite 203, Boynton Beach, Florida 33426. Swan Home Care Services, Inc. is licensed as a home health agency under license number 299992817, with an expiration date of July 10, 2011. Swan Home Care Services, Inc. was at all times material hereto a licensed home health agency under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT TI SWAN HOME CARE SERVICES, INC. DEMONSTRATED A PATTERN OF BILLING PAYERS FOR SERVICES NOT PROVIDED Section 400.474(4), Florida Statutes (BILLING FOR SERVICES NOT PROVIDED) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation conducted on 10/20/2010 and based on staff interview and record review, the Home Health Agency (HHA) demonstrated a pattern of billing payers for services not provided to their clients for three of three sampled clients (Client #1, #2 and #3). . 8. Review of Client #1's record revealed a copy of a signed Client Agreement, dated 03/08/10, for Home Care services. Further review reveals evidence of documentation that the services may include home care aide, companion, sitter placement and/or Supervisory assessment necessary to manage the client's well being; it further documents that services are Planned for twelve hours a day, seven days per week and Client #1 agreed to pay $14.00 an hour. fn addition, the agreement also documented that the client's insurance pays $100.00 per day and that the client is responsible for the difference. 9, Review of the client's weekly time sheet, used to document the care/date/time of service by the Home Health Agency's care giver, revealed the client was cared for on 03/27/10 from 9:00 a.m. to 7:00 p.m. for a total of 10 hours. The corresponding invoice to the client, for the care, documented that the client was charged $168.00 for 12 hours of care and not for the 10 hours documented, as being provided, on the time sheet. 10. Further review of the client's weekly time sheets and the HHA's invoices, revealed three additional similar occurrences: An invoice, for 05/04/10, charged the Client $112.00 for care and review of the weekly time sheet documented zero (0) hours worked by the HHA staff for that day. An invoice for care on 05/19/10 charged the Client $112.00 and the weekly time sheet documented zero (0) hours worked. Further review reveals another bill for $112.00, the equivalent of eight (8) hours worked on 05/22/10 and the time sheet documented only 7 hours worked, 11:00 a.m. to 6:00 p.m. 11. In an interview with the Administrator on 10/20/10 at 2:30 p.m., she acknowledged the conflicting documentation and provided copy of a correspondence received from Client #1 that: documented, "Below is a list of hours, I owe you (the HHA) a total of 199 hours...make it an even 200 hours at $14.00 is $2,800.00. The amount the HHA charged my account without permission was $5,009.00; it should have been $2,800.00...due to me (Client #1) is $2,209.00." 12. The Administrator stated, during the interview, on 10/20/10 at 2:30 p.m., that she sent the client a check for $2,200.00 and asked the client not to cash it until 09/15/10. The Administrator stated, during the interview, on 10/20/10 at 2:30 p.m., that she knows that the check was returned for non- sufficient funds but after receiving correspondence from the Client's Attorney, she turned it over to her Attorney and she confirmed that the client had not received the money owed. The Administrator could not produce a copy of this check for $2,200.00 that was sent to the client. 13. Review of Client #2's record revealed copy of a signed Client Agreement dated 06/22/09, for home care services. It documented that the services may include home care aide, companion, sitter placement and/or supervisory assessment necessary to manage the client's well being. In addition, services were planned for four and a half hours a day, seven days per week, The client's rate was $14.00 per hour, the insurance company pays $70.00 per day, and the client is to pay the difference. 14. Review of the client's. time sheet for the week of January 11-16 of 2010, reveals evidence of documentation that care was rendered every day for 4 hours, 10:00 a.m. to 2:00 p.m. with the exception of January 14, 2010 where it was documented that care was for 3 hours, 10:00 a.m. to 1:00 p.m. The HHA's corresponding invoice for the same week, January 11- 16 of 2010, revealed the HHA billed the client $70.00 a day and not $56.00 and $42.00 it should have charged respectively. Purther review of that invoice reveals evidence of documentation that there was a charge for $70.00 on 01/17/10 but the client's time sheet documented zero (0) hours worked. Continued review, revealed that for the week of January 25-31, 2010, the HHA billed for $70.00 for five hours per day, which is the maximum amount the client's insurance pays per day. However, documentation reveals that the HHA only provided care for four hours on the 25th, 27th and 28th of January; and three and a half hours of care on the 26th of January. Continued review revealed that the other days, January 29, January 30 and January 31, the time sheet documents zero (0) hours of care. In an interview with the Administrator on 10/20/10 at 2:30 p.m., she acknowledged the conflicting documentation. 15. Review of Client #3's record revealed a copy of a signed Client Agreement dated 02/17/09, for home care services. It further documents that the services may include home care aide, companion, sitter placement and/or supervisory assessment necessary to manage the client's well being. In addition, those services were planned for four to five hours, five days a week. The client's rate was documented as $15.00 per hour and there was no evidence of documentation how much or if the client's insurance company will pay for the services. The client's time sheet for the week including April 19-23 of 2010, documented that three hours of care was rendered on 04/23/10. The client's invoice revealed evidence of documentation that the client was billed $60.00 for that day, not $45.00, as should have been, per the client and Home Health Agency's agreement. In an interview with the Administrator on 10/20/10 at 2:30 p.m., she acknowledged the conflicting documentation. 16. Based on the foregoing facts, Swan Home Care Services, Inc. violated Section 400.474(4), Florida Statutes, herein a deficiency, which carries in this case an assessed fine of $5,000.00 x 3 patients= $15,000.00. 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 Swan Home Care Services, Inc. on Count I. 2. Assess against Swan Home Care Services, Inc. an administrative fine of $15,000.00 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 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. lgon E. Rodney, Esq. Assistant General Coufisel Agency for Health Care Administration | 8333 NW 53%¢ Street, Suite 300 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (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 Andrea Marie Dawes, Swan Home Care Services, Inc., 2500 Quantum Lakes Drive, Suite 203, Boynton | ind Beach, Florida 33426, on this II day of penny , 2011. Ak E. ee USPS - Track & Confirm : INI STATES NPE, Page 1 of 1 Track & Confirm Search Results Label/Receipt Number: 7009 0080 0000 0586 3835 Service(s): Certified Mail™ Status: Delivered Your item was delivered at 10:57 am on January 12, 2011 in BOYNTON BEACH, FL 33426. Detailed Results: » Delivered, January 12, 2011, 10:57 am, BOYNTON BEACH, FL 33426 * Arrival at Unit, January 12, 2011, 7:53 am, BOYNTON BEACH, FL 33426 Notification Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email. {@a>_} Sie Customer Service Forms Govt Sonices Careers Privacy Policy, Copyright® 2010 USPS. All Rights Reserved. NoFEARActEEO Data FOIA http;//rkenfrm1.smi.usps.com/PTSInternet Web/InterLabelInquiry.do Business Customer Gateway 02/03/2011 f SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY mm Complete items 1,2, and 3. Also complete A. Signature ip : ras __ Item 4 If Restricted Delivery Is desired. yy C2 \ Dagent | i Print your nama.and address on the reverse Cl Addressee_' so that we can return the card to you, «i... ) wt Attach this card to.the back of the mailplece, or on the front If space permits. 1, Article Addressed to: ~ |)", Recetved by (Printed Name) | C. Date of Delivery He CA pene y cai D.'ls delivery address different from item 1? Yes ' It YES, enter delivery address below: C1No 8.: Service Type Sertified Mall 1 Express Mall | O33 Cl Be ‘ i : . jedlatered HGturn Recelpt for Merchandise : Bua. rack EL 23426 a ineured Mall oo. “ gale / 4. Restricted Delivery? (Extra Fea) Dyes (DavtceNomber nme oman nnnn neal amar. : | % aoe tnte 7009 0080 DODO O58 3835 102595-02-M-1540 | FLORIDA AGENCY FOR HEALTH CARE ADMINS TRATION RICK SCOTT . ELIZABETH DUDEK GOVERNOR Better Health Care for all Floridians INTERIM SECRETARY January 5, 2011 Administrator Swan Home Care Services Inc. 2500 Quantum Lakes Dr. Ste. 203 Boynton Beach, FL. 33426 RE: CCR#2010010281 Dear Administrator: This letter reports the findings of a Complaint Inspection survey revisit conducted on December 22, 2010 by a representative of this office. Attached is the provider's copy of the State Form:Revisit Report, which indicates the previously cited deficiencies were found corrected on the day of the revisit. The Quality Assurance Questionnaire has long been employed to obtain your feedback following survey activity. This form has been placed on the Agency's website at http://ahea.myflorida.com/Publications/Forms, shtml as a first step in providing a web-based interactive consumer satisfaction survey system. You may access the questionnaire through the link under Health Facilities and Providers on this page. Your feedback is encouraged and valued, as our goal is to ensure the professional and consistent application of the survey process. Thank you for the assistance provided to the representative. Should you have any questions please call this office at (561) 381-5840, Sincerely, Arlene Mayo-Davis Field Office Manager AMD Enclosure: State Form:Revisit Report JSXD — eee ee Delray Beach Field Office 5150 Linton Boulevard, Suite 500 Delray Beach, FL 33484 i Phone (561) 381-5840; Fax {561) 496-5924 | Headquarters 2727 Mahan Drive Tallahassee, FL 32308 http://ahca.myflorida.com AH Form Approved 1/5/2011 State Form: Revisit Report (Y1) Provider / Supplier / GLIA? Yo {Y¥3) Date of Revisit Identification Number A. Building HH19965540 _ _ Be Wing ee ae | __tre2/2010 “Name of Facility Street Address, City, State, Zip Code oe SWAN HOME CARE SERVICES INC 2500 QUANTUM LAKES DR STE 203 This report is completed by a State surveyor to show those deficiencies previously reported that have been corrected and the date such corrective action was accomplished, Each deficiency should be fully identified using either the regulation or LSC provision number and the identification prefix code previously shown on the State Survey Report (prefix codes shown to the left of each requirement on the Survey report form). (V4) Item (¥5) Date (¥4) Item _ _{¥8) Date (Y4) Item one AVS) Date Correction Correction Correction Completed Completed Completed ID Prefix _H0130 ___ 12/22/2010 ID Prefix HO365 12/22/2010 ID Prefix 40) Reg. # 400.474(4), FS. Reg.# lsc . LSC ene Cm nena Correction Correction Correction Completed Completed Completed ID Prefix ID Prefix 7 a i 'D Prefix — Reg. # Correction Correction Correction Completed Completed Completed ID Prefix ae ID Prefix _ ee 'D Prefix Reg. # oe _ Reg. # Reg. # a usc Lsc __ Lsc — ———— ><>» ——_—— Correction Correction Correction Completed Completed Completed ID Prefix 1D Prefix _ eee. i ID Prefix Reg. # Correction Correction Correction Completed Completed Completed ID Prefix oe ID Prefix ve 1D Prefix ae Reg. # _ . Reg. # . _. Reg. # oe Lsc ise Lsc oo SS ——_—_—___ —— Reviewed By va Reviewed By Date: Signature of Surveyor: Date: StateAgency fT bt lidaon HET Lif) Uy Reviewed By ——.._ | Reviewed By Date: Signature of Surveyor: Date: CMS RO Followup to Survey Completed on: Page 1 of 1 EventID: VRFO12

Docket for Case No: 11-000675

Orders for Case No: 11-000675