STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

2017 APR 17 p 3: trl

Petitioner,

vs.

FMC HOSPITAL LTD. D/B/A FLORIDA MEDICAL CENTER, A CAMPUS OF NORTH SHORE MEDICAL CENTER, INC.

DOAH CASE NO.: 16-3544MPI C.I. NO.: 14-0352-000

·o :t

MPI CASE NO.: 2015-0002042 PROVIDER ID NO.: 010214800 NPI NO.: 1265469605 LICENSE NO.:4207

RENDITION NO.: AHCA· r1 ).7 (\ · 1

Respondent.

                                                                    I

FINAL ORDER

THE PARTIES resolved all disputed issue s 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 /'.f y of         , 2017, in Tallahassee,

Florida.

Age ncy for Health Care Admini stration vs. FMC HOSPITAL , LTD. D/B/A FLORIDA MEDICAL CENT ER, A CAMPUS OF NORTH SHORE MEDIC AL CENTER, INC.

(C.I. No. : 1 4-0352-000

MPI CASE NO.: 201 5-0 0 02042)

Final Or der Page I of 3

Filed April 25, 2017 9:45 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 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:

FMC Hospital, LTD

DBA Florida Medical Center, A Campus of North Shore Medical Center, Inc.

Attn: Oksana Baczyk, Hospital Compliance and Privacy Officer

5000 West Oakland Park Blvd. Lauderdale Lakes, Fl. 33313-1503 (U.S. Mail)

Kelly Bennett

Agency for Health Care Administration Chief of Medicaid Program Integrity (Electronic Mail)

Michael J. Glazer Ausley/McMullen 123 S. Calhoun Street Tallahassee, FL 32301

850-425-5474

mglazer@ausley.com (Electronic Mail)

Ephraim D. Livingston, Esquire Agency for Health Care Administration

Ephraim.Livingston.@ahca.myflorida.com (Electronic Mail)

Bureau of Financial Services

Agency for Health Care Administration (Electronic Mail)

Health Quality Assurance

Agency for Health Care Administration (Electronic Mail)

Agency for Health Care Administration vs. FMC HOSPIT AL, LTD. D/B/A FLORIDA MEDICAL CENTER, A CAMPUS OF NORTH SHORE MEDICAL CENTER, INC.

(C.I. No.: 14-0352-000

MP! CASE NO.: 2015-0002042)

Final Order Page 2 of 3

CERTIFICATE OF SERVICE

J/uf

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 /

,2017.

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

Agency for Health Care Administration vs. FMC HOSPITAL, LTD. D/B/A FLORIDA MEDICAL CENTER, A CAMPUS OF NORTH SHORE MEDICAL CENTER, INC.

(C.I. No.: 14-0352-000

MPI CASE NO.: 2015-0002042)

Final Order Page 3 of 3

Docket for Case No: 16-003544MPI

Orders for Case No: 16-003544MPI