,...._ .' 1

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STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF. FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

. , . . . --

i', ' I i, ' ,;..\:.

2014 CCT -9 A IQ: 31

vs.

P<.'titioncr,

l)OAII Case No: 14-2456 MPI

C.I. No: 12-2625 -000

NPI No: I 730117003

Provider No: 000455900

olf

License No: 0S4773

RENDITION NO.: AHCA· \ 4 - 0 3 -S-MDO

GARY MARDER D.O.

Respondent.

-------------'/

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 2-<>,(day of          , 2014, in Tallahassee,

Florida.

Agency for Healt Care Administration

Agency For Healthcare Administration V. Gary Marder D.O. C.I. No. 12-2625-000

Filed October 14, 2014 2:14 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 AHC\, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LA \V, 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:

Robert Antonie Milne. Esq .. Assistant Attorney Ge,wral Florida Bar No.: 622338 Office of the Attorney General The Capitol, Suite PL-0 I

Tallahassee, Florida 32399-1050

Telephone: (850) 414-3713

Facsimile: (850) 922-6425 Robert.Mi Ine@myt1orida lega I.com

Julie Gallagher, Esq., Julie.gallagher@akerman.com Akerman Scntcrfitt

Suik 1200

106 East College Avenue

Tallahassee, Florida 32301

Kelly Bennett, Chief

Medicaid Program Integrity Finance and Accounting Health Quality Assurance Florida Department of Health

Agency For Hec1lthcare Administration V. Gary Marder D.O. C.I. No. 12-2525-000

CERTIFICATE OF SERVICE

r HEREBY CERTIFY th;it 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 -

     014.

hoop, Esquire Agency Clerk

State o!' 1-:']cwida

Agc-ncy lor l kulth Care Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

(850) 412-3630/FAX (850) 921-0158

Agency For Healthcare Administration V. Gary Marder D.O. C.I. No. 12-2625-000

STAT!( OF FLORIDA

AGENCY FOR HEALTH CARE ADMINJSTRA'l'ION

STATE OF FLORIDA, AGENCY ll'OR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

GARY L. MARDER, D,0.

Respondent.

                                                              I

DOAH CASE NO: 14-2456MPI

PROVIDER NO.: 000455900

C.L NO.: 12-2625"000

NPI NO.: 1730117003

LICENSE NO: 084773

SETTLEMENT AGREEMENT

Petitioner, the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, ("AHCA" or "Agency"), and Respondent, GARY L. MARDER, D.O.

("PROVIDER"), hy and through the undersigned, hereby stipulate hnd agree as follows:

1. The parties enter into this agreement for the purpose of memorializing the resolution of this matter.

2. PROVIDER is a Medicaid provider in the State of Florida, provider number

   
   

   000455900, and was a provider during the audit period.

   
   

3. In its Final Audit Report, dated October 7, 2013, the Agency notified PROVIDER that a review of Mcdicuid duims pcrCorrnecl by the Agency's Of'!lce of the Insp,'.ctor General, Bureau of Medicaid Program Integrity ("MPI"), during the period of December l, 2008, through May 31, 2011, indicated that certain claims, in whole or in pai1, were inappropriately paid by

   Agency for Health Care Administration v. Gary L. Marder, D.O.

   C.I. No 12-2625-000

   Settlement Agreement Page 1 of6

   
   

   
   

   Medicaid. The Agency sought repayment of this overpayment, in the amount of one hundred and fifty-four thousand five hundred and sixty-four dollars and six cents ($154,564.06). Additionally, the Agency applied sanctions in accordance with Secli1ms 409.913(15), (16), and (l 7), Florida Statutes, and Rule 590-9.070(7), Florida Administrative Code. Specifically, the Agency assessed the following sanctions against PROVIDER: a fine in the amount of thirty thousand nine hundred and twelve dollars and eighty-one cents ($30,912.81) for violation(s) of Rule 59G-9.070(7)(c), Florida Administrative Code; and costs in the ammmt of three thousand, five hundred and fifty-five dollars and twenty cents ($3,551.20). The total amount due was one hundred and eighty-nine tho11sand, t wcnty-cight dollars and seven cents ($ l 89,028.07).

4. ln rc::;ponse to the audit report dated October 7, 2013, PROVIDER filed a !'tJti!ion

   
   

   for Formal Administrative Hearing.

   
   

5. Subsequent to issuance of the FAR, the PROVIDER submitted additional documentation and clarifications to ARCA regarding the alleged overpayment and sanctions

   amount. Based on further review AHCA has revised the final overpayment to one hundred forty

   five thousand, four liundrccl doll<1rs and twenty-five cents ($145,400.25). The Agency also imposed a sanction in the nrncnmt of six thou:.;and dollms ($6,000.00) and assessed cos1 in the amount of three thousand, seven hundred fifty-one dollars and twenty cents ($3,751.20), The total amount due arising from this case is one hundred fifty-five thousand, one hundred fifty-one hundred dollars and forty-five cents ($155,151.45).

   6, In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA agree as follows:

   Agency for Health Care Adrninblralion v. Gary L. Marder, 0.0.

   C.I. No 12-2625-000

   Settlement Agreement

   Page 2 of 6

   
   

   1. AHCA agrees to accept the payment set forth herein in settlement of the after, fines and costs, arising from the above-referenced Audit.

   2. PROVlDER agrees to pay AHCA the sum of one hundred fifty-five thousand, one

      
      

      lrundrcc! fifty-one dollars and forty-five cents($ I 55,15 l .:15). Tlic outstanding bufancc accrues at l 0% interest per year. Within thirty (30) days of entry of the Final Order but by no later than December 10, 2014, whichever date is the last to occur, PROVIDER will make one payment of one hundred fifty-five thousand, one hundred fifty-one dollars and forty-five cents ($155,151.45),

      
      

   3. PROVIDER and AIICA agree that full payment, as set forth above, resolves and settles this case completely and releases both parties from any administrative or civil liabilities arising from the findings relating to the claims determined to have been overpaid as referenced in audit C.I. NO.: 12-2625-000.

   4. PROVIDER agrees that it shall not re-bill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the review in this case.

6. Payment shall be made to:

   
   

   AGENCY FOR HEALTH CARE ADMINISTRATION

   Medicaid Accounts Receivable - MS #14 2727 Mahan Drive, Bldg. 2, Ste-200

   Tallahassee, Florida 32308

   
   

7. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute PROVIDER'S authorization for the Agency, without further

   Agency for Hea!lh CiHe /\drninistr,ition v. Gary L. Murder, D.O. C.I. No 12-2625-000

   Settlement Agreement

   Page 3 of6

   
   

   notice, to withhold the total remaining amount due under the terms of this agreement from any monies due rind owing to PROVIDER for any Medicaid claims.

8. AHCA reserves the right to enforce this Agreement under the laws of tbe State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations.

9. This settlement does not constitute an admission of wrongdoing or en-or by either party with respect to this case or any other matter.

10. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into U1is Agreement on behalf of the respective parties.

11. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida,

12. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there arc no

    promi::.;cs, representations or agreements between PROVIDER and AIICA otb.::r thrill as set forth

    
    

    herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties.

13. This is an Agreement of Settlement and Compromise, made in recognition that the parties may have different or incorrect understandings, infom1ation and contentions as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, in!'t.1nnation and contentions as to facts and lnw, so tnat no misun<lerslandi11g or misinformation shall be a ground for rescissio11 hereat.

    Agency for Health Care Administration v. Gary L. Marder, D.O.

    C.I. No 12-2625-000

    Settlement Agreement Page 4 of 6

    
    

14. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with tile terms of this settlement agreement in any forum now or in the f'l.:turc avrdlable to it, including the right to any administrative proceeding, circuit or federal court action or any appeal.

15. PROVIDER does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nflture whatsoever, arising out of or in any way related 1o this nrnttcr, ABC/\ 's actions herein,

    including, but not limited to, any claims that were or may be asserted in any federal or state court

    
    

    or administrative forum, including any claims arising out of this agreement.

    
    

16. The patties agree to bear their own attorney's fees and, except those cost specified to be paid by the Provider in this settlement agreement if any.

17. This Agreement is and shall be deemed jointly drafted and written by all parties to

    
    

    it and shall not be construed or interpreted against the party originating or rrcpm-ing it.

    
    

18. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement.

    Agency for Health Care Administration v. Gary L. Marder, D.O. C,I. No 12·2625-000

    Settlement Agreement

    Page of 6

    
    

19. This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees.

20. All times stated herein are Qfthe essence of this Agreement.

    
    

21. This Agreement shall be in full fonc and effect upon ei1.:cution by the rosp-ictivc

Dated; 2014

AGENCY FOR HEALTH CARE

ADMINISTRATION

· llah •'see, 1 L 230&-·41:Q

2727 Mahan Drive, Bldg. 3, Mai! Stop #3

Dated,       /t(;'.2011

Dated: 2014

Datcd:42014

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Dated: _Q;/ /</ ,20 l 4

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Agency for Health Care Administration II, Gary l Marder, D.O.

Cl. No 12-2525·000

Settlement AP,reernent

Page 6 of 6

RICK SCOTT

GOVERNOR

GOVERNOR

FlORIDA AGENCY FOR HEAIJH (.ARE ADMINISTRATION

ELIZABETH DUDEK

SECRETARY

i::1..1"-l"\cr::, n uvur;;r-.

SECRETARY

ICA

CERTIFIED MAIL No.: 7009 2820 0001 5675 2068

October 7, 2013

Provider No: 000455900

NPI No: 1730117003

License No.: OS4773

Gary L. Marder

9580 S. US Highway 1

Port St. Lucie, FL 34952-4217

In Reply Refer to

FINAL AUDIT REPORT

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C.I.: No. 12-2625-000

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Dear Provider:

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The Agency for Health Care Administration (Agency), Office oflnspector General, Bureau of Medicaid ! Program Integrity, has completed a review of claims for Medicaid reimbursement for dates of service ! during the period December I, 2008, through May 31, 2011. A preliminary audit report dated October !

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15, 2012 was sent to you indicating that we had determined you were overpaid $145,400.25. Based upon a review of all documentation submitted, we have determined that you were overpaid $154,564.06 for services that in whole or in part are not covered by Medicaid. A fine of $30,912.81 has been applied. The cost assessed for this audit is $3,551.20. The total amount due is $189,028.07.

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Be advised of the following: I

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1. In accordance with Sections 409.913(15), (16), and (17), Florida Statutes (F.S.), and Rule . 590-9.070, Florida Administrative Code (F.A.C.), the Agency shall apply sanctions for violations of federal and state laws, including Medicaid policy. This letter shall serve as notice of the following sanction(s):

   
   

   • A fine of $30,912.81 for violation(s) of Rule Section 590-9.070(7) (e), F.A.C.

     
     

2. Pursuant to Section 409.913(23) (a), F.S.1 the Agency is entitled to recover all investigative, legal, and expert witness costs.

This review and the determination of overpayment were made in accordance with the provisions of Section 409.913, F.S. In determining the appropriateness of Medicaid payment pursuant to Medicaid

policy1 the Medicaid program utilizes procedure codes, descriptions 1 policies 1 limitations and

;; :: so;:: ;;::Mcffldpro derh.d &ction4 09: 3 :: ;;::::o;r

1 1

Gary L. Marder 000455900

C.I. No.: 12-2625-000

Page2

Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicable rules

M9..M. jc:.lW,fys, §£hR-ciR{e l 1S£Q!YYll¥i\;l).<!1VMl\t ftiwtlUJ>glim hi\ 9 erl'd1lh1llirtflJ°'U/}p!leJon!1fu1e!t

and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines.

Below is a discussion of the particular guidelines related to the review of your claims, and an explanation of why these claims do not meet Medicaid requirements. The audit work papers are attached, listing the claims that are affected by this determination.

REVIEW DETERMINA TION(S)

l. Medicaid policy addresses the requirements for enrollment and participation in the Medicaid program. In order to bill for services provided by another practitioner (physician, ARNP, PA), that practitioner must be enrolled in Medicaid, and must also be enrolled as part of a group practice for which you are listed as the pay to provider. The billing must reflect the Medicaid number of the treating practitioner. You billed and received payment for services performed by another practitioner who was not enrolled in Medicaid and/or not in a group with you at the time the services were rendered. This finding applies to pathology claims. Payment made to you for these services is considered an overpayment.

1. A review of your medical records revealed that some services rendered were erroneously coded on the submitted claim. The appropriate code was applied and the payment adjusted. The difference between the amount paid and the payment for the correct procedure code is considered an overpayment.

   
   

2. Medicaid policy requires that services performed be medically necessary for the diagnosis and treatment of an illness. You billed and received payments for services for which the medical records, when reviewed by a Medicaid physician consultant, indicated that the services provided did not meet the Medicaid criteria for medical necessity. The claims which were considered medically unnecessary were disallowed and the money you were paid for these procedures is considered an overpayment.

   
   

3. Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. The documentation you provided supports a lower level of office visit than the one for which you billed and received payment. This detennination was made by a peer consultant in accordance with Sections 409.913 and 409.9131,

   F.S. The difference between the amount you were paid and the correct payment for the appropriate level of service is considered an overpayment.

   
   

4. Medicaid policy addresses the type of pathology services covered by Medicaid. You billed and received payment for laboratory tests that were performed outside your facility by an independent laboratory. Payments made to you in these instances are considered overpayments.

   
   

5. Medicaid policy specifies how medical records must be maintained. A review of your medical records revealed that some services for which you billed and received payment were not documented. Medicaid requires documentation of the services and considers payments made for services not appropriately documented an overpayment.

   Gary L. Marder 000455900

   C.I. No.: 12-2625-000

   Page 3

   
   

   7 In m-rlPr to mm lifv ::i-: ::i h::i<si<: for reimhursement. Medicaid oolicv reauires that records must be

6. In order to qualify as a basis for reimbursement, Medicaid policy requires that records must be signed and dated at the time of service, or otherwise attested to as appropriate to the media. Payments made to you in instances where the records submitted for review were non­

   contemporaneous, are considered overpayments.

   
   

7. Medicaid policy requires a physician's signature to substantiate the service billed. A review of your medical records revealed that in some instances, a rubber stamp was used in lieu of a physician's written signature. Rubber stamp signatures must be initialed. The services that you

   billed and received payment for, in which a rubber stamp was utilized, are considered overpayments.

   
   

8. Medicaid policy states that, to receive the physician I 00% reimbursement, Advanced Registered Nurse Practitioners and Physician assistants must be supervised by the treating physician. Supervision is shown by the physician's dated signature on the medical record. You billed Medicaid for services at the I 00% reimbursement level when the medical record did not indicate

   that the service was supervised. Twenty percent of the reimbursement is considered an overpayment.

   
   

9. Your records indicate instances of unbundling (using two CPT codes when one of these codes incorporates the elements of the other). The unbundled code has been denied.

   
   

10. As to Recipient #25: Medicaid requires a radiological physicist to be under the direct supetvision of a physician (2010 Physician Services Coverage and Limitations Handbook, 2- 115). When Dr. Marder was out of the country he was not on the premises to provide direct supervision for these services. Medicaid requires indirect supervision by a physician for non­ invasive radiology and nuclear medicine services (2010 Physician Services Coverage and Limitations Handbook, 2-112). Indirect supervision means that the physician must be reasonably available, so as to be physically present to provide consultation or direction in a timely fashion as required for appropriate care of the recipient. When Dr. Marder was out of the country, he was not available to provide indirect supervision for services. Dr. Marder was also unavailable to prescribe services for this recipient. CPT code 77401 is allowed once per patient per session regardless of the number of treatment areas. CPT code 77427 is billed per 5 treatments (not areas). CPT code 77336 is billed once per week. CPT code 77300 requires a prescription by the physician. Payments made to you for these services are considered an overpayment.

OVERPAYMENT CALCULATION

A random sample of 35 recipients respecting whom you submitted 388 claims was reviewed. For those claims in the sample, which have dates of service from December 1, 2008, through May 31, 20I 1, an overpayment of$15,169.48 or $39.09659794 per claim, was found. Since you were paid for a total (population) of 10,485 claims for that period, the point estimate of the total overpayment is I0,485 x

$39.09659794 = $409,927.83. There is a 50 percent probability that the overpayment to you is that

amount or more.

Gary L. Marder 000455900

CJ. No.: 12-2625-000

Page4

We used the following statistical formula for cluster sampling to calculate the amount due the Agency:

Where:

t. t,

E = point estimate of overpayment = F[ A,/ B,]

u

F = number of claims in the population = L B,

A, = total overpayment in sample cluster B, == nwnber of claims in sample cluster U = number of clusters in the population

N = number of clusters in the random sample

1

Y = mean overp§eyment per claim = INAINL B,

,_, 1=1

t = t value from the Distribution of t Table

All of the claims relating to a recipient represent a cluster. The values of overpayment and number of claims for each recipient in the sample are shown on the attachment entitled "Overpayment Calculation Using Cluster Sampling." From this statistical formula, which is generally accepted for this purpose, we have calculated that the overpayment to you is $154,564.06 with a ninety-five percent (95%) probability that it is that amount or more.

If you are currently involved in a bankr!Jptcy, yoµ hoµl<;l notify your attorney immediately and provide a copy of this letter for them. Please advise your attorney that we need the following information immediately: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division); and, (4) the name, address, and telephone number of your attorney.

Gary L. Marder 000455900

C.l. No.: 12-2625-000

Page 5

If you are not in bankruptcy and you concur with our findings, remit by certified check in the amount of

$189,028.07, which includes the overpayment amount as well as any fines imposed and assessed costs. The check must be payable to the Florida Agency for Health Care Administration. Questions regarding procedures for submitting payment should be directed to Medicaid Accounts Receivable, (850) 412-3901. To ensure proper credit, be certain you legibly record on your check your Medicaid provider number and the C.I. number listed on the first page of this audit report. Please mail payment to:

Medicaid Accounts Receivable - MS # 14 Agency for Health Care Administration 2727 Mahan Drive Bldg. 2, Ste. 200

Tallahassee, FL 32308

Pursuant to section 409.913(25)(d), F.S., the Agency may collect money owed by all means allowable by law, including, but not limited to, exercising the option to collect money from Medicare that is payable to the provider. Pursuant to section 409.913(27), F.S., if within 30 days following this notice you have not either repaid the alleged overpayment amount or entered into a satisfactory repayment agreement with the Agency, your Medicaid reimbursements will be withheld; they will continue to be

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withheld, even during the pendency of 311 administrative hearing, until such time as the overpayment [ amount is satisfied. Pursuant to section 409.913(30), F.S., the Agency shall terminate your participation !in the Medicaid program if you fail to repay an overpayment or enter into a satisfactory repayment t agreement with the Agency, within 35 days after the date of a final order which is no longer subject to

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further appeal. Pursuant to sections 409.913(15)(q) and 409.9 l 3(25)(c), F.S., a provider that does not !

adhere to the terms of a repayment agreement is subject to termination from the Medicaid program. Finally, failure to comply with all sanctions applied or due dates may result in additional sanctions being

imposed.

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You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. If a request i for a formal hearing is made, the petition must be made in compliance with Section 28-106.201, F.A.C. t and mediation may be available. If a request for an informal hearing is made, the petition must be made

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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.

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Gary L. Marder 000455900

C.I. No.: 12-2625-000

Page 6

Anv m1P:stions vo11 m::iv h:we ahout this matter should be directed to: Kris Creel. Investie:ator. Ae:encv

Any questions you may have about this matter should be directed to: Kris Creel, Investigator, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 412-4600, facsimile (850) 410-1972.

AHCA Administrator Office of Inspector General Medicaid Program Integrity

RO/KC/re

Enclosure(s) Copies furnished to:

Julie Gallagher

Akerman Senterfitt Suite 1200

I 06 East College Avenue Tallahassee, FL 32301

Finance & Accounting (Interoffice mail)

Health Quality Assurance (E-mail)

Department of Health (E-mail)

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Gary L. Marder 000455900

C.I. No.: 12-2625-000

Page 7

NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS

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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 heating pursuant to Seetion 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

informal administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section !

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120.573, Florida Statutes, mediation may be available if you have chosen a formal administrative hearing, as i discussed more fully below.

The written request for an administrative hearing must conform to the requirements of either Rule 28-

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106.20 I (2) or Rule 28- I 06.30 I (2), Florida Administrative Code, and must be received by the Agency 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:

Richard J. Shoop, Esquire

Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop # 3 Tallahassee, Florida 32308

Fax: (850) 921-0158

Phone: (850) 412-3630

The request must be legible, on 8 ½ by I I-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. An explanation of how your substantial interests will be affected by the action described in the FAR;

J, A statement of when and how you received the FAR;

1. For a request for formal hearing, a statement of all disputed issues of mater1ai fact;

2. For a request for formal hearing, a concise statement of the ultimate facts alleged, as well as the rules and statutes which entitle you to relief;

3. For a request for formal hearing, whether you request mediation, if it is available;

4. For a request for informal hearing, what bases support an adjustment to the amount owed to the Agency;

   and

5. A demand for relief.

A fonnal hearing will be held if there are disputed issues of material fact. Additionally, mediation may be available in conjunction with a fonnal 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 I 0 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.

If a 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 forth in the FAR shall be conclusive and final.

FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

Provider: 000455900 - GARY L MARDER

Overpayment Calculation Using Cluster Sampling by Reclp Name Dates Of Service: 12/1/2008 through 5/31/2011

NPI: 1730117003

.J,1,,..- ._..,,.

:,.....--,,,>. -

, • .._ ............,,.~ _1. Act'\,,, --- 1n 1')')1:')J,;_MI\

If you choose to make payment, please return this page along with your check to:

I

Agency for Health Care Administration Medicaid Accounts Receivable

2727 Mahan Drive, Mail Stop #14 t

'

Tallahassee, Florida 32308 l

The check must be made payable to: !

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Florida Agency for Health Care Administration

Check Number:

#          _

Any questions you may have about this matter should be directed to: Kris Creel, Investigator, telephone (850) 412-4600, facsimile (850) 410-1972.

Payment for Medicaid Program Integrity Audit

(Page 1 of 1)

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• Print your name and addresa on the 1'8118\'M

Item 4 ff Reatrtcted Oellv«y le desired.

□Addressee  

□ Agent

• Attach this caret to 1he back of the mallplece,

' or on the front If space permits.

1. Article AddnlSSeCI 10:

80 that We can Nlum the card to you..

D. 18 addrm9 dlff..-itflom ltem.1? □Yea

11 YES, enter deli'le,y address below; □ No

GARY L MARDER 9580 S. US HIGHWAY 1

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PORT ST LUCIE, FL 34952-4217 C.I. # 12-2625-000 KC-re

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4. Rablolld DellVlry? (&t,11Fa.I □'Ills

7009 2820 0001 5 75 2068 /

PS Fann 381_t, February 2004 Domesllc Aatum Rac:elpt 102995-02-M-1540

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UNITED STATES POSTAL SERVICE

111111

272"7 Mgahan Drive, MS #6

Tallahassee, Florida 32308 Medical Unit

Flrst-Class Mall Postage & Fees Paid USPS

Pennlt No. G-10

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Docket for Case No: 14-002456MPI

Orders for Case No: 14-002456MPI