l)

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f, J : : : .

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION 2020 MAY 12 A lO: Ob

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner ,

vs.

N BROWARD HOSP DIST D/B/A

BROW ARD GENERAL MED CTR. FI KJ A NORTH BROW ARD MED CTR.,

DOAH CASE NO.: l 7-0131MPI MPI C.I. No.: 13-0122-000

MPI CASE NO.: 2015-0001979

PROVIDER NO.: 010012901

NPI NO.: 1285662239

LICENSE NO.: 4128

RE"'DITIO"' "'0.: AHCA- 2-o - , 5 0 -S-MDO

Respondent.

I

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the tenns of the attached settlement agreement. Based on the

foregoing, this file is CLOSED.

DONE and ORDERED on this the ay of 1M

Leon County, Florida.

2020, in Tallahassee,

Agency for Health Care Administration

AHC A vs. N Broward Hosp Dist d/b/a Broward General Med Ctr. fik/a No rth B roward Med Ctr. DOAH Case No.: 1 7-0131 MPI MPI C ase No.: 201 5-0001 9 79 MPI C.l. No.: 1 3-0122-000

Provider No.: 01 001 290 I NPI No .: 1 285662239 Licen se No.: 4 1 28 Page I o f 3

Filed May 18, 2020 11:23 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:

AHCA vs. N Broward Hosp Dist d/b/a Broward General Med Ctr. ilk/a North Broward Med Ctr. DOAH Case No.: 17-0131 MP! MP! Case No.: 2015-0001979 MP! C.I. No.: 13-0122-000

Provider No.: 010012901 NP! No.: 1285662239 License No.: 4128

Page 2 of 3

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 f

-/7Id---+/

--- 2020.

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

AHCA vs. N Broward Hosp Dist d/b/a Broward General Med Ctr. flk/a North Broward Med Ctr. DOAHCaseNo.: l7-0131MPI MPICaseNo.:2015-0001979 MPIC.I. No.: 13-0122-000

Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128

Page 3 of3

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OFFLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

j

I

Petitioner

MPIC.I.NO.:

13-0122-000

SETTLEMENT AGREEMENT

Petitioner, the STATE OF FLORIDA, AGENCY FOR HEALTH

I

I

CARE

I

ADMINISTRATION ("AHCA" or "Agency''), and Respondent, N BROWARD HOSP DIST

I

D/B/A BROWARD GENERAL MED CTR FIKJA NORTH BROWARD MED CTR.

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("PROVIDER"), by and through the undersigned, hereby stipulate and 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 nwnb

   
   

   010012901, and was a provider during the audit period.

   ,

3. In its Final Audit Report (attached as Exhibit A), dated November 22, 2016, the

   I

   Agency notified PROVIDER that a review of Medicaid claims performed by the Agencyjs

   . '

   Bureau of Medicaid Program Integrity ("MPI''), during the period of January 1, 2008, throu h

   I

   December 31, 2008, indicate.d that certain claims, in whole or in part, were inappropriately p d

   
   

   AllCA vs. N Broward Hosp Dist D/B/A Broward General Med Ctr F/K/A North Broward Med Ctr.

   MPI C.I. No.: 13-0122-000 MPI Case No.: 2015-0001979

   Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128 Settlement Agreement

   Pagel of7

   
   

   byMedicaid. The Agency sought repayment of this overpayment, in the amount of seven hundred

   
   

   eight thousand, seven hundred ninety-four dollars and twenty-nine cents ($708,794.29). Additionally, the Agency applied a fine in the amount of two thousand, :five hundred dollL

   • ($2,500.00) and costs in the amount of thirty-four thousand, nine hundred sixty-two dollars Jnd

     I

     thirty-one cents ($34,962.31) pursuant to section 409.913(23)(a), Florida Statutes. The tal

     I

     amount due was seven hundred forty-five thousand, nine hundred fifty-nine dollars and J.ty

     cents ($745,959.60). !

     
     

4. In response to the Final Audit Report dated November 22, 2016, PROVIDER filed

   a Petition for Fonnal Administrative Hearing. l '

5. On April 7, 2017, and several dates thereafter, an Order was issued placing the case

   I

   in abeyance during the litigation of Lee Memorial Health System Gulf Coast Medical Centefi v.

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   Agency for Health Care Administration,DOAH Case No. 15-3876, First District Court of Appeal

   I

   I

   Case No. 1D16-1969 ("GulfCoast"),AHCA v. Lee Memorial Health System dlb/a Lee Memori_al

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   i

   Hospital, Case No. 14-4171MPI & l 5-3271MPI, First DCA No. ID16-.3975 (Lee Memorial) and

   I

   I

   AHCA v. Cape Memorial Hospital, Inc. dlbla Cape Coral Hospital, Case No. 14-3606MPI, Fitst

   DCANo. JD16-5310 (Cape Memorial). On February 27, 2019, the First District Court of Appe'al

   I

   issued its Opinion in the cases mentioned above finding in favor of the hospitals. The MandJte

   I

   for each case was issued on June 18, 2019.

   
   

6. In light of the ruling of the First District Court of Appeal, PROVIDER and AHCA agree as follows:

   1. The Final Audit Report dated November 22, 2016 is rescinded.

   2. As of the date of this Settlement Agreement, AHCA has

      
      

      AHCA vs. N Broward Hosp Dist D/B/A Broward General Med Ctr FIK./A North Broward Med Ctr.

      MPI C.I. No.: 13-0122-000 MPI Case No.: 20IS-0001979

      Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128 Settlement Agreement

      Page 2 of7

      r-,

      I

      
      

      collected monies· from PROVIDER totaling seven hundred eight thousand, seven hwidred ninety-four dollars and twenty-nine cents ($708,794.29). (''the Refund Amount").

   3. Within thirty (30) days of'AHCA's receipt of this Settlement Agreement executed by PROVIDER, AHCA shall issue a Final Order adopting this Settlement Agreement.

   4. Within fifteen (15) days following issuance of a Fina1 Order, the Revenue Section of AHCA's Financial Services ("Financial Services") shall forward PROVIDER a Refund Applicatjon reflecting the refund of seven hundred eight thousand, seven hlllldred ninety-four dollars and twenty-nine cents ($708,794.29) due to PROVIDER.

   5. Once AHCA's Financial Services section bas received a complete, correct, and original signed Refund Application, the Refund Applicati911 will be processed and transmitted to the Department of Financial Services within fifteen days of receipt.

   6. Payment of the refund shall be made within thirty (30) days of Financial Services' submission of and the Florida Department of Financial Services' ("DFS") approval of the signed Refund Application.

7. PROVIDER and AHCA agree that full payment, as set forth above, resolves a4d

   
   

   AHCA vs. N Broward Hosp Dist D/B/A Broward General Med Ctr F/KJA North Broward Med Ctr.

   MPI C.I. No.: 13-0122-000 MPI Case No.: 2015-0001979

   Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128

   Settlement Agreement Page3 of7

   
   

   settles this case completely and releases both parties from any administrative or civil liabilities

   arising from the findings referenced in audit C.I. Number 13-0122-000 (MPI Case No.: 2015- 0001979).

   . I

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

9. This settlement does not constitute an admission of wrongdoing or error by eiJer

   '

   party with respect to this case or any other matter.

   
   

10. The signatories to this Agreement, acting in a representative capacity, represent t1kt

    I

    I

    they are duly authorized to enter into this Agreement on behalf of the respective parties. I

    I

11. This Agreement shall be construed in accordance with the provisions of the.laws 'of

    I

    Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida. I

12. This Agreement constitutes the entire agreement between PROVIDER and AHC ,

    I

    t

    including anyone acting for, associated with, or employed by the parties, concerning this matter

    I

    and supersedes any prior discussions, agreements, or understandings. There are no promises,

    t

    I

    representations, or agreements between PROVIDER and AHCA other than as set forth herein. No

    I

    modification or waiver of any provision shall be valjd unless a written amendment to the

    Agreement is compl ted and properly executed by the parties.

    '

    I

13. This is an Agreement of Settlement and Compromise, made in recognition that the

    'I

    I

    parties may have different or incorrect understandings, information, and contentions as to fa ts

    t I

    and law, and with each.party compromising and settling any potential correctness or incorrectness

    . i

    ofitsunderstandings, infonnation, and contentions as to facts and law, so that no miswiderstandiJg

    
    

    AHCA vs. N Broward Hosp Dist DIB/A Broward General Med Ctr F/KJA North Broward Med Ctr.

    MPI C.I. No.: 13-0122-000 MPI Case No.: 2015-0001979

    Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128

    Settlement Agreement Page4of7

    
    

    or misinfonnation shall be a ground for rescission hereof.

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; 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 so long as paymLt

    of the Refund Amount is made in accordance with the tenns of this Settlement Agreement as Lt

    I'

    forth herein. PROVIDER further agrees that it shall not challenge or contest any Final Order

    I

    entered in this matter, which is consistent with the terms of this Settlement Agreement in ly

    I

    forum now or in the future available 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

    I

    
    

    Administration, and its employees, agents, representatives, and attorneys of and from all claJs,

    
    

    demands, actions, causes of action, suits, damages, losses, and expenses, of any and every naJe

    I

    whatsoever, arising out ofor in any way related to this matter, AHCA's actions herein, including,

    I

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

    . I

    administrativeforum, including any claims arising out of this agreement except that PROVIDER

    i

    I

    reserves its rights to enforce the provisions of this Settlement Agreement.

    
    

16. The parties agree to bear their own attorney's fees and costs.

    
    

17. This Agr ent is and shall be deem. ed jointly drafted and written by all parties toI ,it

    and shall not be construed or interpreted against the party originating or preparing it. ,

    
    

18. To the extent that any provision of this Settlement Agreement is prohibited by

    
    

    law for any reason, such.provision shall be effective to the extent not so prohibited, and such

    
    

    AIIGA vs, N Broward Hosp Dist D/B/A Broward General Med Ctr F/K./A North Broward Med Ctr.

    MPI C.I. No.: 13-0122-000 MPI Case No.: 2015-0001979

    Provider No.: 010012901 NP! No.: 1285662239 License No.: 4128 Settlement Agreement

    Page5 of7

    
    

    prohibition shal1 not affect any other provision of this Agreement; provided, however, that in the event that payment is not made to PROVJDER as set forth hl-'Tein, this entire Settlement Agreement is null and void and Provider retains its rights to b,ing any actions necessary to recoup the Refund Amount set forth herein.

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 of the essence of this Agreement.

    
    

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

N BROWARD HOSP DIST D/8/A

BROWARD GENERAL MED CTR F/K/A

NOR:;r1: 5f

(Signed) Authonzcd Representative

Date: <>i!O

N BROWARD HOSP DIST D/8/A

N0RT'i/i,R0W!91'DMED CTR.

BROWARD GENERAL MED CTR F/K/ A

BY: 1/e fe, ty.,,-,r/ct-1 C fc

(Print Name and Title) >

L.:

Broward

Date: f 'f/JOJ.O

AHCA vs. N Broward Hosp Dist D/B/A Broward General Med Ctr F/K)A North Broward Med Ctr.

MP! C.J. No.: 13-0122-000 MPI Case: No.: 2015-0001979

Provider\lo.:010012901 NPlNo.: 1285662239 L!censeNo.:4128 Scttk.'Tl11:nt Agreement

Pag1: 6 of7

AGENCY FOR HEALTH CARE ADMINISTRATION

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

Tallahassee, L 32308- 403

olly

eputy

rHQA

Date: , (I 2Jf

R.w, e

/7- _) Date: S-l 2(#)0

Stefan Esqui

General Counsel

SL.

Date:

4/29Zf!

Shena L. Grantham, Esquire

MAL & MPI Chief Counsel

9;:,: ··

Josephtflern, Irsquire

Medicaid Adrnin. Litigation

Counsel

Date:

,/t1 c11 17

20jef

-i,.

20),§

AHCA va. N Broward Hosp Dist D/B/A Broward General Med Ctr F/K/A North Broward Med Ctr.

MPI C.I. No.: 13-0122--000 MPI Case No.: 201S-0001979

Provider No.: 010012901 NPI No.: 1285662239 License No.: 4128 Settlement Agtt.e.ment

Page7 of7

I

RICKSCOTT

GOVERNOR

I

I

JUSTIN M.SENiOR

INTERIM SECRETARY

CERTIFIED MAIL No.: 917199 9991 7033 2219 5712

November 22, 2016

Provider No.: 010012901

NPINo.: 1285 2239

License No.! 4128

N BROWARD HOSP DIST

DBA BROW GEN MED/NORTH BROWARD MED CTR.

PO BOX 932540

ATLANTA,GA 31193-2540

In Reply Refer to

FINAL AUDIT REPORT

CJ.: No. 13-0122;.()()0 or MPI case No: 2015-0001979

Dear Provider:

• I

of

The Agency for Health Care Administration (Agency), Office of the Inspector General, Medicaid

Program tY,. has compl areview of claims for Medi .rejmbu:rsement for dates service during e-period January 1, 2008, through December 31, 2008. A preliminary audit repo11 dated May 10, 2016 was sent to you indicating that we bad determined you were overpaid

$771,467'.0S. Based upon a review of all documentation submitted, we have-determined that you were overpaid $708,497.29 for claims that in whole or in part are not covered by Medicaid. A tin of $2,500.00 bas been applied. The cost assessed for this audit is $34,962 31. The total amolDlt

due is s14s,9s9.60. · I

Beadvised of the following: J

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 violatfons of federal and state laws, including Medicaid policy. This letter shall serve asnotice of the following sanction(s):

   • A fine of$2,500.00 forviolation(s) of Rule Section 590;;9.070(7) (c), F.A.C.

1. Pursuant to Section 409.913(23) (a) F.S . the Agency is entitled to recover a1J

   investigative, legal. and expert witness costs.

   
   

   •

   2727 Mahin Drive • Meil Stop #6 Tallahassee, FL 32308 AHCA.Myflorlda.com

   EXHIBIT

   Pr

   Facebook.com/AHCAFlorlda' Voutube.com/AHCAFlotid;i' Twitter.com/AHCA_FL' Sl1deSh1r.e.net/AHCAFlorlda

   , ·,

   ,,,, .....

   • I

\., -·

Ploridcr: N BROWARD HOSP DJSTIBROWARD GEN MED

I

Providar No.:0100121101 I

CJ. No 13-0122-000 or'MPJ Ca.w No: 2015 1979

Pagc2 I

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This review and the detenninationsof ovetpayment were made in accordance with the provisions of Section 409.913, F.S. In determining payment pursuant to Medicaid policy, the Medicaid program utilizes descriptions, policies and the limitations and exclusions found in the Medicaid provider handboo In applying for Medicaid reimbursement, providers are required to follov, the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, b etins. and the Medicaid provider agreement. Medicaid C811D6t pay for services,that do not meet these guidelines.

Emergency Medicaid for Aliens (EMA)isa Medicaid limited covemge program in whichcoverage is only for the duration of the emergency. Definitions for Emergency Medical Conditi Emergency Services and Care or Medical Necessity. may be found in the Florida Medicaia

Provider Qe. ner..al H' an••.dbooL. ' Other relevant definitions may be found in the FloridJa

Adminislmtive Code Florida Statutes and in federal law. J

Below is a discussion of the particular guidelines reJatecl to the review of EMA claims and an explanation of why these claims do not meet Medicaid requirements. A list of the paid claim's affected by this determination is attached.

QVIEW DETERMINATION(S)

for

The Medicaid Provider General'Handbook(s}; 2007. page 3-19, and..19Qt page 3-22, e.flablis Limited Coverage Categories and pfugram Codes for programs with.limited 'Medicaid benefits. Medicaid policy related to tl)e program; Emergency Medicaid for Aliens, is further descn'bed. Th Hog;ital Services Coverage pd'Limita1ionsHandboo 2005, page 2-7, also refers to Emergency Medicaid for Alien$.policy. These ,policy references state: "Eligibility can be authorized only

the duration of the CJJ1ergency. Medicaid will notpay for continuous or episodic services after the

emergency has alleviated. Medicaid Provider Reimbursement Handbook UB-04, 2007.pag 2-7 states: "Medicaid coverage of inpatient services for non-qualified, non-citi7.cns is limited emergencies, newbom delivery services and dialysis services." i

I

was

does

A medical recon:l review was performed by a medical review team including a peer physiciart reviewer··who ,determined the point at which tho alien recipient's emergent complaint alleviated. Medicaid policy not allow payment of claims for services rendered beyond th date the emergency has been alleviated. Although medical necessity may continue to Medicaid is not responsible for paYJDent of those continuing services. Consequently, the inpati services billed to and paid by-Medicaid beyond the peer reviewer's determined date of alleviation are identified as an overpayment and are subject to recoupment. :

'

I

In instances where hospital observation days were allowed, claims were adjusted·to allow thJ outpatient per diem for observations, and the difference was identified as an overpayment an4 subject to recoupment.

i

In instances where the medical record was not received or was incomplete, the related claim waJ denied. The Medicaid Provider.General Handbook(s), 2007 and 2008. page 5-8, state following:

,,,........._

I

·-

ProYider; N BROWARD HOSP DIST/BROWARD GEN MEO

Pro idctNo.:0100]:zg()J

C.J. No.:13-0122-000 orMPJ Case No: 201S-000l979

Pagel

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"Incomplete records are records that lack documentation that all requirements orconditions for service provision have been met. Medicaid may recover payment for :services or goods when the provider has incomplete records or cannot locate the records."

In accordance with Medicaid policies, those claims not supported by docwnentation are identified as overpayments and subject tp adininistrat!ve sanction and recoupment. :

'

The Medicaid Provider General Handbook(s). 2007 and 2008, page 5-3, defines ''Overpayment" as: I

I

"Overpayment includes any amount that is not autboriz.ed to be paid by the Medicaid program whether paid asa!'C$Ult of inaccurate or improper cost reporting. improper c , unacceptable practices, fraud, abuse. or mistake."

If you are currently involved in a: bankruptcyJ you should notify your attorney immediately and then provide them a copy of this letter. Please advise your attorney that we require the followirig information immediately: '

1. the date of filing of the bankruptcy petition;

2. the case number; 1

3. the court name and the division in which the petition was filed (e.g., Northern District f

   Florida, Tallahassee Division); :

4. the name, address. and telephone number of your attorney. '

   If you are not in bankruptcy and you concur with our findings, r t payment by certified chec in the amount of $745 959.60, which includes the overpayment emom1t as well as any fines imposed and assessed costs.

   The check must bepayable to the Florida Agency for Healtll Care Administration.

   To ensure pl'9per credit, be certain you legibly record on your check your -Medicaid provide'r number and the c.J. number listed on-tile first page ot this audit repart. Please mail pa.ymeqt

   to

   . I

   • I

   Medicaid Accowrts Receivable• MS # 14 •

   Agency for Health Care Administration 2727 Mahan Drive Bldg. 2, Ste. 200

   Tallahassee, FL 32308

   Questions regarding procedures for submitting payment should be directed to Medicaid Accounts Receivable, (850) 412-3858.

   Pursuant to Section 409.913(25Xd), 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. The Final Audit Report constitutes a probable cause determination by the Agency that you were oveq,aid by the Medicaid program. Thi correspondence is being sent to the address last shown on your provider enrollment file in compliance with Section 409.913(6), F.S. Thus, pursuant to Section 409.913(27), F.S., ifwi 30 days following this notice you have not either repaid thealleged ovetpayment amount or enterec;l into a satisfactory repayment agreement with the Agency, your Medicaid reimbmsements will be withheld; they will continue tobe withheld, even during the pendency of an arlmioistTative bearing

   I

   Provider. N BROWARD HOSP DIST/BROWARD OEN MED

   Pmldcr No.:010012901

   C.I. No.:13-0122-000 or MPI Cast No: 2015-00019'19

   faF4

   until such time as die oveipayment 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 oveq,ayment or enter into a satisfactory repayment agreement with-the Agency, within 35 days after the date of a final order which is no longer subject to further appeal. Pursuant to Sections 409.913(15)(q) and 409.913(25Xc), F.S., a provider that does not adhere to the terms of 1a

   repayment agreement is subj¢ to termination from the Medicaid program. Finally, failure to

   comply with all sanctions applie.d or due dates may result in additional sanctions being imposed]

   You have the right to request a fopi1al or informal hearing pursuant to Section 120569, F.S. lfla request for a formal hearing. is,m., the petition must be made in compliance with Rule 28- 106.2!)1. F.A.G. and mediation. ·beavailable. If a request for an informal hearing is made, th

   petition111ust be made in compliance with Rule 28-l06.301, F.A.C. Additionally, you are hereby infolDled that if a requ for a bearing is made, the petition must be received by tlae Agency within twenty-one (21) days of'receipt of this letter. For more information regarding yotir

   hearing and ation'nghts; please.1ee the attached Notice of Admlniitrative Hearing an

   Memarlon R.ight1. I

   I

   Section 409.913(12), F.S., provides emptions from the provisions of Section 119.07(1), F.S fo the plamt and i nob_tajned pursuant to an in adon of a Medicaj p vider reJating to an allegation pfualld, abuse, or neglect. The Agency bas made the determmatton that;

   yourviolation(s) ofM caid,po}i y constitute abuse.as refetencedin Section409.913, F.S. Thus, all info on obtaip. t tothis review is"confidential and:.eKempt from the provisions f Section 119.07(1), F.S., untjl the Agency takes final agency action with respect to the provider apd requires repayment of any overpayment or imposes an administrative sanction by Final Order. I

   I

   I

   Any questions you may have about this matter should be directed to: Mechelle Davis, AHCA Investigator, Agency for Health Care Administration, Office of Inspector General. Medicaitl Program Integrity, '2727 Mahan·Jilrive,MailStop #6, Tallahassee, Florida 32308-5403, telepho : (850) 412-4600;facsimile: (850) 410-1972.

   ,14 .

   Sincerely,

   
   

   Bob R. Reifinger

   Program Administrator Otnce oflospector General Medicaid Program Integrity BRR/MD/c:w

   Enclosure(s): Provider Overpayment Remittance Voucher

   Notice of Adminis1rative Hearing and Mediation Rights

   Paid Claims Report

   Medical Peer Review Worksheets

   Copies furnished to: Finance & Accounting (Interoffice mail)

   Health Quality Ass\vance (E-mail)

   Provider: N BROWARD HOSP DIST/BROWARD GEN MED

   Provider No.;OJ 0012901

   C.L No.: IJ-0122-000 orMPl CaseNo:1015-0001979

   P,geS

   
   

   l!nal Audit Report.lFAR)

   Provld !-OverpaymentRemittJn youdier

   ,Complete_. is-form and send 8Iong with your clieclc: to: Medicaid Accounts Receivable - MS # 14

   Agency for Health Care Administration 2727 Mahan Drive Bldg. 2, Ste. 200

   Tallahassee, FL 32308

   
   

   CHECK MUST BE MADE PAYABLE TO: FLORIDAAGENCYFORHEALTII CARE

   ADMINISTRATION

   
   

   Provider Name:	NBROWARD HOSP DIST/BROWARD GENMBD
   Provider ID:	010012901
   	13-0122-000
   MPICaseNo:	2015-0001979
   Overpayment Amount:	$708,497.29
   Costs:	$34,962.31
   Fines:	$2,500.00
   Total Due:	$745.959.60
   Check Nwnber:	# ..

   
   

   
   

   A final order will be issued that will include the final identified overpayment, applied Sanctions, and assessed costs, into consid on any information or documentation that you have already submitted. Any amowit·due will be offset by any amount already received by the Agem:y in this matter.

   
   

   Payment for Medicaid Program Integrity Audit

   ,I.

   
   

   Pi:ovidcr: N BROWARD HOSP DISTll:lROWARD OEN MED

   PIUViderNo.:Of0012901

   Cl. No.: 13-0122-000 or MPI Case No: 2015-0001979

   Pagc6

   
   

   NOTICE OF ADMJNISTRA'[JYIHEARING AND MEDIATION RIGHTS

   You haw!he right to request an administrative heating pursuant to Sections 120.569 and 120.57, Florida 1 ·

   Statutes. If you disagree with the facts in the fon1going Final.Audit Report{hereinafter FAR). you may request a

   I

   fonnal administrative hearing pUISUant-to Section 120.57(1), Florida Statutes. Jf yw 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 informa1

   adm istrative he uaot to Section 12 .57(2), Florida Statutes. Additi ly•• to S on 120.573,I Flonda Statutes, mediation may be avat'lable 1fyou have chosen a fonnal adminiStrative hearing, as discussed more· fully below.

   The written request for an adminisntive hearing must conform to therequirements of either Rule 28· 106.201(2) or Rnle 28--106.301(2),' Florida Administrative Code, and must bereceiyed by lhe Agency for Heakh.Care Administration, by 5:00 P.M. no later1han 21 days after you received the FAll. The address for fifing the written request for an administrative hearing is:

   
   

   IUchanl J. Shoop. Esquire

   Agt11cy Clerk

   Agency far Health Care Administration 2n1 Mabaa Drive, Mall Stop# 3 Tallahu • 32308

   .

   Fall: (850)'21-fl158and Phone: (850) 412-3630

   £.Fila Website; http:1/apps.abea.myOorlda.comtEfile

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   Pethiom for bearing filed purnaat tll the administrative process of Cbapter 120, Florida Statntes may be filed wiUi tha Apnq by U.S, 111111 or courlei sent to tlte Agency Oark at tbe address list.eel above. by baad ddwtry at theaddress listed above, by faalmlle transmission to (850) 92l-4HSI, or by electronic ffling through the Agency's &-File website at listed above. The request must be legi'ble, on 8 ¼ by 11-inch white paper, and contain: !''

   1. Your name, address, telephone . any Agency identifying number on the PAR, ifknown, and name;

addms, and telephone number of your representative, if any; I

1. An explanation of how your su tial interests wUI be affected by the action descn'bed inthe FAR; '

2. A statemem of when and how you n:ceived the FAR;

3. For a request for foanal hearing, a statement of all disputed issues of material met; j

4. For a request for formal hearing, a concise statement of the ultimate facts alleged, as well as the rules and 1

   statutes whicti enntle you to relief; j

5. For.arequest.fbr funnaI hearing. whether you request mediation, ifit is available; I

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

7. A demand for relief. l

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A formal hearing will be held if there are disputed issues of material fact. Additiollally, mediation may be, i

available in c:owuo¢on with a formal hearing. Mediation is a way to use a neutral third party to assist the parties inia legal or administrative proceeding to reach a settlement of their case. Jfyou 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.

It you request mediation. and th Agency agrees to it, you will be contacted·by the Agency to set upa time 'for

the mediation and to enter into a mediation agreement. lf a mediation agreement is not reached within 10 days following the request for memation, the matter will proceed without mediation. The mediation must be concluded 1 within 60 days of having entered Into the agreement, unless you and the Agency agree to a ditfenmt time period. The mediation agreement between you and the Agency will include provisions for selecting the mediator. the allocation of costs and fees assC>ciated. with the mediation, and the dentiality 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.

Docket for Case No: 17-000131MPI

Orders for Case No: 17-000131MPI