STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ,

2017 MAY -5 A 9: 0 I

vs.

Petitioner,

DOAH CASE NO.: 14-5304MPI MPI CASE NO.: 2015-0002708 C.I. NO.: 11-1434-000

PROVIDER NO: 010041200

NPI NO: 1063442770 LICENSE NO .: 4347

TENET HIEALEAH HEALTH SYSTEMS, INC.,*

Respondent.

                                                                       I

FINAL ORDER

P.[NOITION NO.: AHCA·\1 O )tS-MDO

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 ---4_ day of 017, in Tallahassee, Florida.

1us?/4 trv

Agency for Health Care Administration

*NIKIA, Hialeah Hosp ital, Inc.

I

Agency for Health Care Administration vs. Tenet Hialeah Health Systems , Inc.*

(C.l. No.: 11-1434-000; MPI Case No .: 2015-0002708)

Final Order

Filed May 10, 2017 9:10 AM 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 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.

Copies furnished to:

Tenet Hialeah Health Systems, Inc. 4660 Communication Ave

Boca Raton, FL 33431 (U.S. Mail)

Joseph M. Goldstein, Esquire Shutts & Bowen, LLP

200 East Broward Blvd., Suite 2100 Fort Lauderdale, FL 33301

j o ldstein(ri1shutts.com (Electronic Mail)

Kelly Bennett, Chief, MPI (Electronic Mail)

Joanne B. Erde, Esquire Duane Morris, LLP.

200 South Biscayne Blvd., Suite 3400

Miami, Florida 33131 jerde(a:duanernorris.com (Electronic Mail)

Health Quality Assurance (Electronic Mail)

Bureau of Financial Services (Electronic Mail)

2

Agency for Health Care Administration vs. Tenet Hialeah Health Systems, Inc.*

(CL No.: I 1-1434-000; MPl Case No.: 2015-0002708)

Final Order

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 ,5Cr;;of

!%:2011.

Richard J. Shoop, Esquire 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

3

Agency for Health Care Administration vs. Tenet Hialeah Health Systems, Inc.*

(C.I. No.: 11-1434-000; MP! Case No.: 2015-0002708)

Final Order

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH Case No. 14-5304MPI MPI CASE NO.: 2015-0002708 C.I. NO.: 11-1434-000

PROVIDER NO.: 010041200

NPI NO.: 1063442770

LICENSE NO.: 4347

TENET HIALEAH HEALTH SYSTEMS,

Respondent.

                                                                I

SETTLEMENT AGREEMENT

Petitioner, the STATE OF FLORIDA, AGENCY FOR HEALTH CARE

ADMINISTRATION ("AHCA" or "Agency"), and Respondent, TENET HIALEAH HEALTH SYSTEMS, provider number 010041200, ("PROVIDER"), by and through the undersigned, hereby stipulate and agree as follows:

1. The parties agree to settle DOAH Case No. 14-5304MPI (this matter) wherein Provider filed a petition for a formal administrative hearing regarding the Amended Final Audit Report issued by AHCA on July 25, 2014.

2. PROVIDER is a Medicaid provider in the State of Florida, provider number 010041200, and was a provider during the audit period.

3. A preliminary audit report dated July 19, 2011, was sent to PROVIDER indicating that the Agency had determined PROVIDER was overpaid $195,633.15. On November 10, 2011, a Final Audit Report was sent to PROVIDER indicating that the Agency

   
   

   Agency for Health Care Administration vs. Tenet Hialeah Health Systems

   (C. I. No.: 11-1434-000}

   Settlement Agreement Page 1 of 7

   
   

   had determined PROVIDER was overpaid $194,529.61. Thereafter, the Agency issued an Amended Final Audit Report dated July 25, 2014, and submitted it to PROVIDER on October 24, 2014.

4. In its Amended Final Audit Repmt, the Agency notified PROVIDER that a review performed by the Agency's Office of the Inspector General, Bureau of Medicaid Program Integrity ("MPI") of PROVIDER'S Medicaid claims that were rendered during the pe1iod of January 1, 2006, through December 31, 2006, indicated that certain claims, in whole or in part, were inappropriately paid by AHCA. The Agency sought repayment of this overpayment, in the amount of one hundred sixty two thousand, eight hundred twenty six dollars and sixty seven cents ($162,826.67) and assessed the following sanctions in accordance with Sections 409.913(15), (16), and (17), Florida Statutes, and Rule 590-9.070(7), Florida Administrative Code against PROVIDER: a fine in the amount of two thousand, five hundred dollars ($2,500.00) for violation(s) of Rule 59G-9.070(7)(c), Florida Administrative Code; and costs in the amount of three thousand, eight hundred dollars and twenty four cents ($3,800.24). The total amount due was one hundred sixty nine thousand, one hundred twenty six dollars and ninety one cents ($169,126.91).

5. In response to the Amended Final Audit Repmt dated July 25, 2104, PROVIDER timely filed a Petition/or Formal Administrative Hearing.

6. In order to resolve this matter without further administrative proceedings, and

   
   

   based upon additional information received and reviewed by AHCA during the pendency of litigation, PROVIDER and AHCA agree as follows:

   1. AHCA agrees to accept the payment set forth herein in settlement of the

      
      

      overpayment, fine; and costs arising from the above-referenced audit.

      
      

      Agency for Health Care Administration vs. Tenet Hialeah Health Systems

      (C. I. No.: 11-1434-000}

      Settlement Agreement Page 2 of7

      
      

   2. PROVIDER agrees to pay AHCA the sum of one hundred twenty eight thousand, four hundred twenty dollars and twenty four cents ($128,420.24), which includes a total overpayment in the amount of one hundred twenty two thousand, one hundred twenty dollars and no cents ($122,120.00) plus a sanction of two thousand, five hundred dollars ($2,500.00) and costs of three thousand, eight hundred dollars and twenty four cents ($3,800.24).

   3. Any monies PROVIDER has paid to ARCA pursuant to the involuntary lien shall be retained by ARCA as payment of the agreed-upon amount due of one hundred twenty eight thousand, four hundred twenty dollars and twenty four cents ($128,420.24). As of December 21, 2015, AHCA has received payments from the PROVIDER totaling One hundred ninety-fom thousand, five hundred twenty-nine dollars and sixty-one cents ($194,529.61). PROVIDER shall be refunded any amount collected in excess of the agreed upon amount of one hundred twenty - eight thousand, four hundred twenty dollars and twenty - four cents ($128,420.24), as follows:

      1. Within thirty (30) days following the issuance of a Final Order in this case, Financial Services shall forward the Provider a Refund Application reflecting the refund due to the PROVIDER;

      2. Once Financial Services has received the signed Refund Application, the refund will be processed.

         c, Payment of the refund shall be made within thirty (30) day of financial Services receipt of the signed Refund Application,

         
         

         Agency for Health Care Administration vs, Tenet Hialeah Health Systems

         (C. I. No.: 11-1434-000)

         Settlement Agreement

         Page 3 of7

         
         

   4. PROVIDER and AHCA agree that full payment, as set forth above, and already made, resolves and settles this case completely and releases both parties from any administrative or civil liabilities arising from the review determinations relating to the claims as referenced in audit C.I. 11-1434-000.

   5. PROVIDER agrees that it shall not re-bill the Medicaid Program in any manner for the claims that are the subject of the review in this case as specifically identified in the Amended Final Audit Report.

      
      

7. AHCA and PROVIDER each reserve the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations.

8. This settlement does not constitute an admission of wrongdoing or e11·or by either party with respect to this case or any other matter.

9. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on hehalf of the respective patties,

10, 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.

1. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning this matter and supersedes any prior discussions, agreements or understandings regarding this matter; there are no promises, representations or agreements between PROVIDER and AHCA other than 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.

   
   

   Agency for Health Care Administration vs. Tenet Hialeah Heallh Systems

   (C. I. No.: 11·1434-000}

   Settlement Agreement

   Page 4 of 7

   
   

2. This is an Agreement of Settlement and Compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions as to facts and law, and with each party compromising and settling any potential co11"ectness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof.

3. PROVIDER expressly waives 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 matter. PROVIDER further agrees that it shall not challenge or contest any Pinal Order entered in this matter that is consistent with the terms of this Agreement in any fornm now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal.

4. PROVIDER does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature whatsoever, arising in this matter, AHCA'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; provided, however, PROVIDER does not discharge the State of Florida, Agency for Health Care Administration, regarding any other matters related to AHCA's payments, practices, policies or audits of services rendered to undocumented aliens.

   
   

   Agency for Health Care Administration vs. Tenel Hialeah Health Systems (C. I. No.: 11-1434-000)

   Settlement Agreement Page 6 of 7

   
   

5. The parties agree to bear their own attorney's fees and costs, if any, with the exception that the PROVIDER shall reimburse, as pait of this settlement, $2,500.00 in fines. This amount is included in the calculations and demand of paragraph 6(B).

6. 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 paity originating or preparing it.

7. 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; provided, however, if the entitlement to a refund to PROVIDER in paragraph 6 is prohibited, or if a Pinal Order has not been issued within 180 days from the date of signature by PROVIDER, PROVIDER shall have the right to void this Agreement.

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

9. All times stated herein are of the essence of this Agreement.

   
   

10. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart.

THE UEMAINDER OF THIS PAGE IS INTENTIONALLY BLANK

Agency tor Heallh Care Administration vs. Tenet Hialeah Health Systems

(C. I. No.: I 1-1434-000)

Seltlement Agreement Page 6 of 7

TENET HIALEAH HEALTH SYSTEMS

        \ I . 'l C-1,-..1. vvv·                 Dated: l Li \ 21_i1 2016

(Signed)

BY: lL,  ..\,,.k( {\qtu.-.1,vJ 1 (' l"O Tt'.1-·,1.\ F!,,,<r(,,

(Print Name and Title)

AGENCY FOR HEALTH CARE ADMINISTRATION

2727 Mahan Drive, Bldg, 3, Mail Stop #3

Tallahassee, FL 32308-5403

--              

Inspector General

Stuait F. Williams, Esquire General Counsel

Dated: 5pjt7

Dated: y/4:-- ,20#-

ena L. Grantham, Esquire

edicaid Admin. Lit. Chief Counsel

Dated:      

4-+t_f _3  

, 201<7\

Jose , oldstein, Esquire Shu s & Bowen LLP

FTLDOCS 6960518 2

Dated:      

I /_11  

, 201/f

Agency for Health Care Administration vs. Tenet Hialeah Health Systems

(C. I. No.: I 1-1434-000)

Settlement Agreement Page 7 of7

Docket for Case No: 14-005304MPI

Orders for Case No: 14-005304MPI