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AGENCY FOR HEALTH CARE ADMINISTRATION vs CONCORDIA OF FLORIDA, INC., D/B/A CONCORDIA VILLAGE OF TAMPA, 20-000094 (2020)

Court: Division of Administrative Hearings, Florida Number: 20-000094 Visitors: 10
Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: CONCORDIA OF FLORIDA, INC., D/B/A CONCORDIA VILLAGE OF TAMPA
Judges: JODI-ANN V. LIVINGSTONE
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Jan. 09, 2020
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Tuesday, August 11, 2020.

Latest Update: Dec. 25, 2024
Summary: STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION r• sZ. Q 2021 JULU 2`0 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-0094 AHCA NO.: 2019003368 RENDITION NO.: AHCA-21 - 180 -S-OLC CONCORDIA OF FLORIDA, INC. d/ b/ a CONCORDIA VILLAGE OF TAMPA, Respondent. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitio
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20000094_282_08042021_10213723_e



STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION


STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


2021 JUL 20 P 12: OW


Petitioner,

DOAH No.: 20-0094

AHCA NO.: 2019003368

  1. RENDITION NO.: AHCA- 1 \ · 7 8Co -S-OLC


    CONCORDIA OF FLORIDA, INC. d/b/a CONCORDIA VILLAGE OFT AMPA,


    Respondent.

    I


    STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


    Petitioner, DOAH No.: 20-1063

    AHCA NO.: 2019001114

    v.


    JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/b/a JOHN KNOX VILLAGE MED CENTER,


    Respondent.

    I


    FINAL ORDER


    Having reviewed the Administrative Complaints, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:


    1. The Agency issued the attached Administrative Complaints and Election of Rights forms to the respective Respondent. (Ex. 1) The parties have since entered into the attached Settlement Agreement , which is adopted and incorporated by reference into this Final Order. (Ex. 2)


    2. The Respondent [in AHCA No. 2019003368] sha11 pay the Agency $3,000.00 and is assigned conditional licensure status effective January 28, 2019 , and ending January 28, 2019. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the "Agency for Health Care Adm i nistrat io n" and containing the AHCA ten-digit case number should be sent to:


      Filed August 4, 2021 10:21 AM Division of Administrative Hearings

      Central Intake Unit

      Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61

      Tallahassee, Florida 32308


    3. The Administrative Complaint in AHCA No. 2019001114 is withdrawn.

ORDERED at Tallahassee, Florida, on this / day of--'--" '+-"""'1.b.....,. , 202 I.


. Smoak, Deputy Se retary Agency for Health Care Administration


NOTICE OF RIGHT TO JUDICIAL REVIEW


A party who is adversely affected by this Final Order is entitled to 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 of 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.


3/ ,

CERTIFICATE OF SERVICE


I CERTIFY that a true and correctJ::9PY of this Final Order was served on the below-named

persons by the method designated on this 2t1t y of .J--

2021.


. hoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: (850) 412-3630


Facilities Intake Unit

Agency for Health Care Administration (Electronic Mail)

Central Intake Unit

Agency for Health Care Administration (Electronic Mail)


Maurice Boetger, Senior Attorney

Shaddrick A. Haston, Esquire

Office of the General Counsel

Ullman Bursa Law

Agency for Health Care Administration

3812 Coconut Palm Drive, Suite 200

(Electronic Mail)

Tampa, Florida 33619


shaston@ublawoffices.com


(Electronic Mail)

Jodi-Ann V. Livingstone

J. Bruce Culpepper

Administrative Law Judge

Administrative Law Judge

Division of Administrative Hearings

Division of Administrative Hearings

1230 Apalachee Parkway

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

Tallahassee, Florida 32399-3060

(Electronic Filing)

(Electronic Filing)


STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION


STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


Petitioner,


vs.

DOAH No.: 20-0094

AHCA No. 2019003368


CONCORDIA OF FLORIDA, INC. d/b/a CONCORDIA VILLAGE OF TAMPA,


Respondent.

/


STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


Petitioner,


vs.


JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/b/a JOHN KNOX VILLAGE MED CENTER,


Respondent.

-----------------/


DOAH No.: 20-1063

AHCA No. 2019001114


SETTLEMENT AGREEMENT


The Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), and the Respondents, Concordia of Florida, Inc. d/b/a Concordia Village of Tampa and John Knox Village of Tampa Bay, Inc. f/d/b/a John Knox Village Med Center ( collectively or individually "the Respondent"), pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows:

WHEREAS, the Agency is the licensing and regulatory authority over the Respondent pursuant to Chapter 408, Part II, and Chapter 400, Part II, Florida Statutes; and


Page I of6


EXHIBIT 2


WHEREAS, the Respondent is a nursing home licensed pursuant to Chapter 408, Part II, Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code; and

WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019003368) seeking to impose an administrative fine of $3,000.00 and to assign conditional licensure status effective January 28, 2019 and ending January 28, 2019; and

WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019001114) seeking to impose an administrative fine of $1,000.00 and to assign conditional licensure status effective November 27, 2017 and ending November 30, 2017; and

WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of these disputes would avoid the expenditure of substantial sums to litigate these disputes; and

WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement of these proceedings;

NOW THEREFORE, in consideration of these mutual promises and recitals, the parties, intending to be legally bound, agree as follows:

I. All of the above recitals are true and correct and are expressly incorporated into this Agreement.

  1. The above "whereas" clauses are binding findings on the parties.


  2. Upon full execution of this Agreement, the Respondent waives any and all appeals and proceedings to which it may be entitled including, but not limited to, informal proceedings under Subsection 120.57(2), Florida Statutes, formal proceedings under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and further waives compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, this Agreement shall not be deemed a waiver by any party of its right


    to the judicial enforcement of this Agreement.


  3. Upon full execution of this Agreement, in AHCA No.2019003368, the Respondent agrees to pay the Agency $3,000.00 within 30 days of the entry of the Final Order adopting this Agreement.

  4. Upon full execution of this Agreement, in AHCA No.2019003368, the Respondent is assigned conditional licensure status effective January 28, 2019 and ending January 28, 2019.

  5. Upon full execution of this Agreement, the Agency agrees to withdraw the Administrative Complaint in AHCA No. 2019001114.

  6. Venue for any action brought to interpret, enforce, or challenge the terms of this Agreement and adopting Final Order shall lie solely in the Circuit Court of Leon County, Florida.

  7. By entering into this Agreement, the Respondent continues to deny the allegations set forth in the Administrative Complaints, but recognizes that the Agency continues in good faith to assert the validity of the allegations. This Agreement shall not preclude the Agency from imposing any penalty against the Respondent for any other deficiency identified in any other survey of the Respondent. This Agreement shall not preclude the Agency from using the deficiencies from the surveys identified in the Administrative Complaint (AHCA # 2019003368) in any decision regarding licensure of the Respondent. In the event the Agency takes such action in the future, nothing in this Agreement shall serve as a waiver of the Respondent's rights under Chapter 120, Florida Statutes, or other applicable law. In addition, this Agreement shall not preclude or estop any federal, other state agency, or local agency from taking any action against the Respondent based upon, in whole or in part, the allegations set forth in the Administrative Complaints.

  8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating this Agreement and closing the above-styled cases.


  9. Each party shall bear its own costs and attorney's fees.


1 I. This Agreement shall become effective on the date upon which it is fully executed by all parties designated below.

  1. The Respondent, for itself and for its related or resulting organizations, entities, successors, and transferees, attorneys, and heirs, discharges the Agency, its agents, representatives, and attorneys, from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, 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, by or on behalf of the Respondent or related entities.

  2. This Agreement is binding upon all parties and those persons and entities that are identified in the above paragraph of this Agreement.

  3. In the event that the Respondent was a Medicaid provider at the time of the occurrences alleged in the Administrative Complaints, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any further sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any pending or potential federal issues against the Respondent. This Agreement does not prohibit the Agency from taking any action regarding the Respondent's Medicaid provider status, conditions, requirements or contract, if applicable.

  4. The undersigned have read and understand this Agreement and have the authority


    and legal capacity to bind their respective principals. The Respondent acknowledges the right to retain independent counsel and has either obtained its own counsel or voluntarily waived the right to counsel. The Respondent understands that counsel for the Agency represents solely the Agency


    and that counsel for the Agency has not provided any legal advice to, or influenced, the Respondent in the decision to enter into this Agreement.

  5. This Agreement contains the entire understandings and agreements of the parties.


    This Agreement supersedes any prior oral or written agreement that may have existed between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void.

  6. All parties agree that an electronic or facsimile signature suffices for an original signature, that an electronic or facsimile copy suffices for an original document, and that this agreement may be executed in counterparts.

  7. This Agreement shall be effective upon full execution by all parties and adoption into a Final Order. After full execution of this Agreement, the Agency will enter a Final Order adopting this agreement and closing this case.


The following representatives acknowledge that they are duly authorized to enter into this Agreement.


imberly . Sm ak, Deputy Secretary Health Quality Assurance

Agency for Health Care Administration

2727 Mahan Drive, Building #3

Tallahassee, Florida 32308

Hope R dayal

Concordia of Florida, Inc. /a Concordia Village of Tampa (Licensee at the time of the Agency action commenced)

4100 E. Fletcher Ave Tampa, Florida 33613


James D. Varna General Counsel Office of the Geb ral Counsel

Agency for Healf Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florid 32308

Shaddrick A Haston, Esquire Ullman Bursa Law

3812 Coconut Palm Drive, Suite 200

Tampa, Florida 33619

Attorney for Concordia Village


DATED: 7_/1_4/_2_1---


Maurice T. Boetger, Senior Attorney Office of the General Counsel

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

Tallahassee, Florida 32308 DATED: ,J 1-Slil


Docket for Case No: 20-000094
Issue Date Proceedings
Aug. 04, 2021 Settlement Agreement filed.
Aug. 04, 2021 Agency Final Order filed.
Aug. 11, 2020 Order Closing File and Relinquishing Jurisdiction. CASE CLOSED.
Aug. 10, 2020 Joint Motion to Relinquish Jurisdiction filed.
Jul. 15, 2020 Order Rescheduling Hearing by Zoom Conference (hearing set for August 20, 2020; 9:00 a.m.; Tallahassee).
Jul. 15, 2020 CASE STATUS: Status Conference Held.
Jul. 15, 2020 Notice of Telephonic Status Conference (status conference set for July 15, 2020; 11:30 a.m.).
Jul. 13, 2020 Second Status Report filed.
May 13, 2020 Order.
May 13, 2020 Status Report filed.
Apr. 29, 2020 Order Granting Continuance (parties to advise status by May 13, 2020).
Apr. 28, 2020 Respondent's Motion for Continuance filed.
Mar. 09, 2020 Order Granting Continuance and Rescheduling Hearing (hearing set for May 12, 2020; 9:30 a.m.; Tallahassee).
Mar. 09, 2020 Respondent's Motion for Continuance filed.
Jan. 16, 2020 Agency's First Request for Admissions filed.
Jan. 16, 2020 Agency's First Request for Production of Documents filed.
Jan. 16, 2020 Agency's Notice of Propounding First Set of Interrogatories filed.
Jan. 16, 2020 Order of Pre-hearing Instructions.
Jan. 16, 2020 Notice of Hearing (hearing set for March 17, 2020; 9:30 a.m.; Tallahassee).
Jan. 16, 2020 Joint Response to Initial Order filed.
Jan. 10, 2020 Initial Order.
Jan. 09, 2020 Amended Petition for Formal Hearing filed.
Jan. 09, 2020 Administrative Complaint filed.
Jan. 09, 2020 Notice (of Agency referral) filed.

Orders for Case No: 20-000094
Issue Date Document Summary
Jul. 20, 2021 Agency Final Order STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 
r• sZ. 
Q
2021 JULU 2`0 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, 
Petitioner, 
DOAH No.: 20-0094 
AHCA NO.: 2019003368 
RENDITION NO.: AHCA-21 - 
180 -S-OLC 
CONCORDIA OF FLORIDA, INC. d/ b/ a 
CONCORDIA VILLAGE OF TAMPA, 
Respondent. 
STATE OF FLORIDA, AGENCY FOR 
HEALTH CARE ADMINISTRATION, 
Petitioner, 
DOAH No.: 20-1063 
AHCA NO.: 2019001114 
V. 
JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/ b/ a JOHN KNOX VILLAGE MED CENTER, 
Respondent. 
FINAL ORDER 
Having reviewed the Administrative Complaints, and all other matters of record, the Agency for 
Health Care Administration finds and concludes as follows: 
1. The Agency issued the attached Administrative Complaints and Election of Rights forms 
to the respective Respondent. ( Ex. 1) 
The parties have since entered into the attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. ( Ex. 2) 
2. The Respondent [ in AHCA No. 2019003368] 
shall pay the Agency $ 3, 000.00 and is assigned conditional licensure status effective January 28, 2019, and ending January 28, 2019. If full payment has been made, the cancelled check acts as receipt ofpayment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts 
are subject to statutory interest and may be referred to collections. A check made payable to the " Agencyfor Health Care Administration" and containing the AHCA ten -digit case number should be sent to: 
Central Intake Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61 Tallahassee, Florida 32308 
3. The Administrative Complaint in AHCA No. 2019001114 is withdrawn. 
ORDERED at Tallahassee, Florida, on this / ~ ~ day of ~""b 1 , 2021. 
--'1'+"1j"'"---'yl:-1----
. Smoak, Deputy Se retary 
Agency for Health Care Administration 
NOTICE OF RIGHT TO JUDICIAL REVIEW 
A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy ofa notice ofappeal with the Agency Clerk ofAHCA, and a second copy, along with filing fee as prescribed by law, with the District Court ofAppeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition ofthe order to be reviewed. 
CERTIFICATE OF SERVICE 
I CERTIFY that a true and correct-G!WY of this Final Order was served on the below-named persons by the method designated on this 2t1t~y of .--J ~ ,2021. 
. hoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Telephone: (850) 412-3630 
Facilities Intake Unit Central Intake Unit 
Agency for Health Care Administration Agency for Health Care Administration 
(Electronic Mail) (Electronic Mail) 
2 
Maurice Boetger, Senior Attorney Office ofthe General Counsel Agency for Health Care Administration (Electronic Mail) Shaddrick A. Haston, Esquire Ullman Bursa Law 3812 Coconut Palm Drive, Suite 200 Tampa, Florida 33619 shaston@ublawoffices.com 
(Electronic Mail) 
Jodi-Ann V. Livingstone Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) J. Bruce Culpepper Administrative Law Judge Division ofAdministrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) 
3 
STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 
STATE OF FLORIDA, AGENCY FOR 
HEALTH CARE ADMINISTRATION, 
Petitioner, 
DOAH No.: 20-0094 
vs. AHCA No. 2019003368 
CONCORDIA OF FLORIDA, INC. d/b/a CONCORDIA VILLAGE OF TAMPA, 
Respondent. 
----------------------------~/ 
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, 
Petitioner, DOAH No.: 20-1 063 vs. AHCA No. 2019001114 
JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/b/a JOHN KNOX VILLAGE MED CENTER, 
Respondent. 
----------------------------~/ 
SETTLEMENT AGREEMENT 
The Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), and the Respondents, Concordia ofFlorida, Inc. d/b/a Concordia Village ofTampa and John Knox Village of Tampa Bay, Inc. f/d/b/a John Knox Village Med Center ( coJiectively or individually "the Respondent"), pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows: 
WHEREAS, the Agency is the licensing and regulatory authority over the Respondent pursuant to Chapter 408, Part II, and Chapter 400, Part II, Florida Statutes; and 
Page I of6 
EXHIBIT 2 
WHEREAS, the Respondent is a nursing home licensed pursuant to Chapter 408, Part II, Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code; and 
WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019003368) seeking to impose an administrative fine of $3,000.00 and to assign conditional licensure status effective January 28, 2019 and ending January 28, 20 19; and 
WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019001114) seeking to impose an administrative fine of $1,000.00 and to assign conditional licensure status effective November 27, 2017 and ending November 30, 20 17; and 
WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of these disputes would avoid the expenditure of substantial sums to litigate these disputes; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement ofthese proceedings; NOW THEREFORE, in consideration ofthese mutual promises and recitals, the parties, intending to be legally bound, agree as follows: 
I. 
All of the above recitals are true and correct and are expressly incorporated into this Agreement. 
2. The above "whereas" clauses are binding findings on the parties. 
3. 
Upon full execution ofthis Agreement, the Respondent waives any and all appeals and proceedings to which it may be entitled including, but not limited to, informal proceedings under Subsection 120.57(2), Florida Statutes, formal proceedings under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and further waives compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, this Agreement shall not be deemed a waiver by any party of its right 
Page2of6 
to the judicial enforcement ofthis Agreement. 
4. 
Upon full execution ofthis Agreement, in AHCA No. 2019003368, the Respondent agrees to pay the Agency $3,000.00 within 30 days ofthe entry of the Final Order adopting this Agreement. 
5. 
Upon full execution ofthis Agreement, in AHCA No. 2019003368, the Respondent is assigned conditional licensure status effective January 28, 2019 and ending January 28, 20 I9. 
6. 
Upon full execution of this Agreement, the Agency agrees to withdraw the Administrative Complaint in AHCA No. 2019001 I14. 
7. 
Venue for any action brought to interpret, enforce, or challenge the terms of this Agreement and adopting Final Order shall lie solely in the Circuit Court ofLeon County, Florida. 
8. 
By entering into this Agreement, the Respondent continues to deny the allegations set forth in the Administrative Complaints, but recognizes that the Agency continues in good faith to assert the validity of the allegations. This Agreement shall not preclude the Agency from imposing any penalty against the Respondent for any other deficiency identified in any other survey ofthe Respondent. This Agreement shall not preclude the Agency from using the deficiencies from the surveys identified in the Administrative Complaint (AHCA # 2019003368) in any decision regarding licensure of the Respondent. In the event the Agency takes such action in the future, nothing in this Agreement shaH serve as a waiver of the Respondent's rights under Chapter 120, Florida Statutes, or other applicable law. In addition, this Agreement shall not preclude or estop any federal, other state agency, or local agency from taking any action against the Respondent based upon, in whole or in part, the allegations set forth in the Administrative Complaints. 
9. 
Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating this Agreement and closing the above-styled cases. 
Page 3 of6 
10. Each party shall bear its own costs and attorney's fees. 
1I. This Agreement shall become effective on the date upon which it is fully executed by all parties designated below. 
12. 
The Respondent, for itself and for its related or resulting organizations, entities, successors, and transferees, attorneys, and heirs, discharges the Agency, its agents, representatives, and attorneys, from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, 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, by or on behalf ofthe Respondent or related entities. 
13. 
This Agreement is binding upon all parties and those persons and entities that are identified in the above paragraph ofthis Agreement. 
14. 
In the event that the Respondent was a Medicaid provider at the time of the occurrences alleged in the Administrative Complaints, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any further sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any pending or potential federal issues against the Respondent. This Agreement does not prohibit the Agency from taking any action regarding the Respondent's Medicaid provider status, conditions, requirements or contract, if applicable. 
15. 
The undersigned have read and understand this Agreement and have the authority and legal capacity to bind their respective principals. The Respondent acknowledges the right to retain independent counsel and has either obtained its own counsel or voluntarily waived the right to counsel. The Respondent understands that counsel for the Agency represents solely the Agency 
Page 4 of6 
and that counsel for the Agency has not provided any legal advice to, or influenced, the Respondent in the decision to enter into this Agreement. 
16. 
This Agreement contains the entire understandings and agreements of the parties. This Agreement supersedes any prior oral or written agreement that may have existed between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 
17. 
All parties agree that an electronic or facsimile signature suffices for an original signature, that an electronic or facsimile copy suffices for an original document, and that this agreement may be executed in counterparts. 
18. 
This Agreement shall be effective upon full execution by all parties and adoption into a Final Order. After full execution of this Agreement, the Agency will enter a Final Order adopting this agreement and closing this case. 
The following representatives acknowledge that they are duly authorized to enter into this Agreement. 
. Sm ak, Deputy Secretary Health Quality Assurance Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 Concordia ofFlorida, Inc. /a Concordia Village of Tampa (Licensee at the time of the Agency action commenced) 41 00 E. Fletcher Ave Tampa, Florida 33613 
DATED: 
'~[ Hlzt 
Page 5 of6 
Tallahassee, Fl~~~ 3t3l8' . 
I I ' I
I
DATED:__ '·. · ~ 
Maurice T. Boetger, Senior Attorney Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 
DATED: !)/)h., I Shaddrick A Haston, Esquire 
Ullman Bursa Law 
3812 Coconut Palm Drive, Suite 200 Tampa, Florida 33619 
Attorney for Concordia Village 
DATED: ___7_/1_4/_2_1_____ 
Page 6 of6
Source:  Florida - Division of Administrative Hearings

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