{ . STATE OF FLORIDA | -AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR . HEALTH CARE ADMINISTRATION, Petitioner, . “4 a Case No.: 2012009356 ; vs. SENIOR FOCUS HEALTH SYSTEMS LLC d/b/a DIAMOND HOME CARE, Respondent. / ADMINISTRATIVE COMPLAINT The Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, files this Administrative Complaint against Senior Focus Health _ Systems, LLC, d/b/a Diamond Home Care (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION This is an.action to impose a fine in the amount of five thousand dollars ($5,000.00) pursuant to Section 400.474(6), Florida Statutes (2012), for one deficiency. JURISDICTION AND VENUE . 1, The Agency has jurisdiction over the Respondent pursuant to Chapters 400, Part II, and 408, Part II, Florida Statutes, (2012). 2.. — Venue lies pursuant to 120.57, Florida Statutes (2012), and Chapter 28, Florida Administrative Code. PARTIES 3. The Agency is the licensing and enforcing authority with regard to Home Health Agencies pursuant to Chapters 400, Part ITI, and 408, Part II, Florida Statutes (2012) and Chapter 59A-8, Florida Administrative Code. Filed October 1, 2012 1:10 PM Division of Administrative Hearings ~ Se 4. Respondent is a home health agency (hereafter “HHHA”) located at 1240 Marbella Plaza Drive, Suite 120, Tampa, FL 33619, having been issued license number 21492096. | . 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. ) | COUNT I - H0363 6. ) The Agency re-alleges and. incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. Pursuant to Florida law: 1 Administrative penalties (6) The agency may deny, revoke, or suspend the license of a home health = agency and shall impose a fine of $5,000 against a home health agency that: (a) Gives remuneration for staffing services to: 1. Another home health agency with which it has formal or informal patient-referral transactions or arrangements; or 2. Ahealth services pool with which it has formal or informal patient-referral transactions or artangements, unless the home health agency has activated its comprehensive ‘emergency management plan in accordance with.s, 400.492. This paragraph does not apply to a Medicare-certified home health agency that provides fair market value remuneration for staffing services to a non-Medicare-certified home health agency that is part of a continuing care facility licensed under chapter 651 for providing services to its own residents if each resident receiving home health services pursuant to this arrangement attests in writing that he or she made a decision without influence from staff of the facility to select, from a list of Medicare-certified home health agencies provided by the facility, that Medicare-certified home heaith agency to provide the services, aL Le (b) Provides services to residents in an assisted living facility for which the home health agency does not receive fair market value remuneration. (c) Provides staffing to an assisted living facility for which the home health agency does not receive fair market value remuneration. (d) Fails to provide the agency, upon request, with copies of all contracts with assisted living facilities which were executed within 5 years before the request. (e) Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or this chapter from whom the home health agency receives referrals, (f) Fails to submit to the agency, within 15 days after the end of each calendar quarter, a written report that includes the following data based on data as it existed on the last day of the quarter: 1. The number of insulin- -dependent diabetic patients receiving insulin-injection services from the home health . agency; 2. The number of patients receiving both home health services from the home health agency and hospice services; 3. The number of patients receiving home health services ’ ftom that home health agency; and 4. The names and license numbers of nurses whose primary job responsibility is to provide home health services to patients and who received remuneration from the home health agency in excess of $25,000 during the calendar quarter. (g) Gives cash, or its equivalent, to a Medicare or Medicaid beneficiary. (h) Has more than one medical director contract in effect at one time or more than one medical director contract and one contract with a physician-specialist whose services are mandated for the home health agency in order to qualify to participate in a federal or state health care program at one time. : Ma” (i) Gives remuneration toa physician without a medical director contract being in effect. The contract must: 1. Be in writing and signed by both parties; 2. Provide for remuneration that is at fair market value for an hourly . vate, which must be supported by invoices submitted by the medical director describing the work performed, the dates on which that work’ was performed, and the duration of that work; and 3, Be fora term of at least 1 year. The hourly rate specified in the contract may not be increased during © the term of the contract. The home health agency may not execute a subsequent contract with that physician which has an increased hourly tate and covers any portion of the term that was in the original contract. (j) Gives remuneration to: 1, A physician, and the home health agency is in violation of paragraph (h) or paragraph (i); 2. A member of the physician’s office staff, or 3. An immediate family member of the physician, if the home health agency has received a patient referral in the preceding 12 months from that physician or physician's office staff. ({k) Fails to provide to the agency, upon request, copies of all contracts with a medical director which were executed within 5 years before the request. () Demonstrates a pattern of billing the Medicaid program for services to Medicaid recipients which are medically unnecessary as determined by.a final order. A pattern may be demonstrated by a showing of at least two such medically unnecessary services within one Medicaid program integrity audit period, Nothing in paragraph (e) or paragraph (j) shall be interpreted as applying to or precluding any discount, compensation, waiver of payment, or payment practice permitted by 42 U.S.C. s. 1320a-7(b) or regulations adopted thereunder, including 42 C.F.R. s. 1001.952 or s. 1395nn or regulations adopted thereunder. Section 400.474, Fla. Stat. (2012) ee 8. On August 3, 2012, the Agency conducted a Licensure Survey of the home health agency and found the agency out of compliance with the above statute. 9, Based on a review of the home health agency's contract with the Medical Director and invoices submitted, it was unclear as to whether remuneration for an hourly “rate at fair market value was paid. Findings included: . The April 23, 2012, "Retainer Agreement [with the] Medical Director," - under section for compensation - noted: The agency shall pay a stipend in the amount of $1,100 per month to the Medical Director for all services rendered. It is acknowledged by the parties that the actual time for the ‘Medical Director's duties will vary from time to time, but as to the tasks to be performed and the time likely to be required to perform such tasks, the stated compensation is the parties best estimate of the fair market value. Said payment shall be compensation for his/her services as-Medical Director only and does not include any amounts due for professional fees arising from his/her direct care services to residents. A May 15, 2012, invoice submitted by the Medical Director said: "Quarterly _ MD review of charts for billing compliance.” $1,000 was billed. The invoice. did not include dates or the duration of the work performed. A June 13, 2012, invoice submitted by the Medical Director said: "Monthly invoice for April," "Monthly MD review of charts for billing compliance, attendance quarterly PAC meeting." $1,000 was billed. The invoice did not include dates or the duration of the work performed. ' 10. The failure of the facility to.require the medical director to submit invoices describing the work performed, the dates on which that work was performed, and the duration of work to support payments made for services is a violation of law. 11. The Agency is required by law to assess a fine of $5000.00 in accord with Section 400,474, Florida Statutes (2012). WHEREFORE; the Agency intends to impose an administrative fine in the amount of five thousand dollars ($5,000.00), against Respondent, a home health agency in the State 5 ad of Florida, pursuant to Section 400.474, Florida Statutes (2012). NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308; Telephone (850) 412-3671. "RESPONDENT JS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE J HEREBY CERTIFY that a true and correct copy of the foregoing has been served “by Certified U.S. Mail No. 7011 0470 0000 7951 2930 to Registered Agent: David Vaughan, 1240 Marbella Plaza Drive, Tampa, FL 33619, and by regular U.S. Mail to Zangela Montgomery, Administrator, Diamond Home Care, 1240 Marbella Plaza Drive, Tampa, AW . FL 33619, this / if day of September, 2012. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ny la: fe Ne 985775 Assistant General Counsel 525 Mitror Lake Drive, 330H St. Petersburg, FL 33701 (727) 552-1525; Fax: (727) 552-1440. Copy furnished to: Patricia R. Caufman, FOM STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: SENIOR FOCUS HEALTH SYSTEMS LLC , CASE NO: 2012009356 d/b/a DIAMOND HOME CARE | . ELECTION HT: - This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. ve the attached e of to Impose a Late Fe i i Imt Late Fine or 1 Administrative i oe . If your Hlection of Rights with your selected option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order ' will be issued, (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT ONLY 1 OF THES OPTION ONE (1)_._—I admit to the allegations of facts and law contained in the © Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my tight to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. ; OPTION TWO (2)____ I admit to the allegations of facts contained.in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120,.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to. show that the proposed administrative action is too severe or that the fine should be reduced. aa OPTION THREE (3)____ I dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice: of Intent to Impose a Late Fine, or ‘Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before-an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a - formal hearing. You also must file a written petition in oder to obtain a formal hearing ' before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it * contain: 1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed. action. . 4, A statement of all disputed issues of material fact. If there are none, you must state that there are none, - Mediation under Section 120.573, Florida Statutes, may be available i in this matter if the Agency agrees, ' License type:__— (ALF? nursing home? medical equipment? Other type?) - Licensee Name: License number: Contact person: . . , Name Title Address; ——- Street and number ” City Zip Code Telephone No. __ Fax No. Email(optional), . Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name:__ : Title: Late fee/fine/AC

Docket for Case No: 12-003238