STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATI0 016 f pp. I I p I: 09

DOS OF HIALEAH, INC. D/B/A

HILEAH SHORES NURSING & REHAB CENTER

vs.

Petitioner,

CASE NO.: 13-4134

Engagement No: NH04-131S PROVIDER ID NO.: 250988

RENDITION NO.: /\HCA-1 ·01"!0 -S-MO/\

STATE OF FLORIDA,

AGENCY FOR HEALTH CARE ADMINSTRATION,

Respondent.

                                                                    I

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 7 th day of fJJ:JrJ/

I

, 201&>, in Tallahassee,

Florida.

, S CRETARY

Agency for Health Care Administration

DOS of Hiale ah, Inc. d/b/a Hialeah Shores Nursing & Rehab v. AHCA (Case No: 13-4134)

Final Order

Page I of3

Filed April 14, 2016 2:47 PM Division of Administrative Hearings

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 BYLAW, 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.

Copies furnished to:

Kelly Bennett

Agency for Health Care Administration Chief of Medicaid Program Kelly.Bennett:@ahca.mvflorida.com (electronic mail)

Zainab Day

Agency for Health Care Administration Planning Administrator Zainab.Day@ahca.myflorida.com (electronic mail)

Errol Williams

Agency for Health Care Administration Audit Evaluation and Review

Errol.Williams@ahca.mvflorida.com (electronic mail)

Theodore E. Mack, Esquire Powell & Mark, P.A.

803 North Calhoun Street Tallahassee, Florida 32303 tmack@talstar.com (electronic mail)

Ephraim D. Livingston, Esquire Agency for Health Care Administration

Ephraim.Livingston(£Vahca.mvflorida.com (electronic mail)

Agency for Health Care Administration Bureau of Health Quality Assurance (electronic mail)

Agency for Health Care Administration Bureau of Finance & Accounting (electronic mail)

DOS of Hialeah, Inc. d/b/a Hialeah Shores Nursing & Rehab v. AHCA (Case No: 13-4134)

Final Order Page 2 of3

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 or other designated method on this the                    

Richard J. Shoop, Esqm e Agency Clerk

State of Florida

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

Tallahassee, Florida 32308-5403

(850) 412-3689/FAX (850) 921-0158

DOS of Hialeah, Inc. d/b/a Hialeah Shores Nursing & Rehab v. AHCA (Case No: 13-4134)

Final Order Page 3 of3

RICK SCOTT GOVERNOR

FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

  ICA

Better Health Care for all Floridians ELIZABETH DUDEK SECRETARY

DELEGATION OF AUTHORITY

To Execute

FINAL ORDERS related to cost reports

I specifically delegate the authority to execute Final Orders related to cost reports to Justin Senior, Deputy Secretary for Medicaid, or his delegate.

This delegation of authority shall be valid from December 16, 2011, until revoked by the Secretary.

2727 Mahan Drive, MS# Tallahassee, Florida 32308

Visit AHCA online at AHCA. MyFlorida. com

Docket for Case No: 13-004134

Orders for Case No: 13-004134