The Issue The issue to be resolved in this proceeding concerns whether the Petitioners may recover certain costs expended for hiring additional staff, related to patient care and operating changes allegedly made to comply with existing state or federal statutes or rules, by means of the requested interim rate increases.
Findings Of Fact The Respondent, Agency for Health Care Administration (AHCA), as successor-in-interest to the Department of Health and Rehabilitative Services, is the state agency responsible for administering the Florida medicaid program. The nursing home section of the medicaid cost reimbursement division is responsible for setting the rates for Florida nursing homes. That section is also responsible for granting or denying interim rate requests. The office of licensure and certification (OLC), a division of the Agency for Health Care Administration, provides overall regulation for the nursing home industry in the State of Florida. The Petitioners were licensed by the State of Florida as nursing homes and certified for participation in the Florida medicaid program at all pertinent times. The Petitioner, Crestview Nursing and Convalescent Center (Crestview), is a 180- bed nursing home certified to and participating in the Florida medicaid program. It is located in Crestview, Florida. The Petitioner, The Bluffs, Inc., d/b/a The Bluffs Nursing Home (The Bluffs), is a 120-bed nursing home certified to and participating in the Florida medicaid program. It is located in Pensacola, Florida. The Florida medicaid Title XIX nursing home plan (reimbursement plan) is a prospective plan. Costs incurred in a cost-reporting period are submitted on a cost report. Medicaid reimbursement rates based upon such cost reports are then limited by a "target rate" which is facility specific. The target rate is based upon the previous semester's rate times 1.50 of the inflationary factor for that time period in the medicaid program- mandated formula. The nursing home then receives the lower of the costs actually incurred plus the true inflation factor or the nursing home target rate. It happens on occasion that a nursing home may incur additional costs for patient care or operating changes in a particular reporting period, as a result of complying with existing state or federal laws or regulations. In order for the nursing home not to suffer financially due to these additional costs, the reimbursement plan has an allowance for an interim rate increase request. If the interim rate provision were not in the reimbursement plan, the nursing home would never be able to fully recover the increased costs because of the prospective nature of the reimbursement plan and the restrictions of the target rate calculation. Thus, if Crestview and the Bluffs were not permitted an interim rate increase, they would lose the cost coverage from the medicaid program for subsequent years because the reimbursement rates are based upon the previous years' costs and are limited by the target rate calculation. The parties have stipulated that Crestview and The Bluffs have met the threshold requirements set out for an interim rate increase since the costs for which reimbursement is requested are at least $5,000.00 of increase and because the requested rate change would be 1 percent or more of the provider's total per diem rates. Crestview was cited by AHCA's OLC for repeat deficiencies in the areas of nutritional care and related weight loss by residents, decubitus care, and restraints utilization, in surveys conducted by that agency in July of 1991, November of 1991, and two surveys in February of 1992. These citations were for quality of care conditions recognized by the inspectors, as well as Lois Petty, director of nursing services for Crestview, as constituting violations of state and federal laws, rules and standards. Crestview maintains that it attempted to correct the cited violations by utilizing its existing staff, but was unsuccessful, and contends that it would not have been possible to come into compliance with the state and federal laws involved concerning quality of care without the costs of the additional staff that it hired and for which it seeks the interim rate increase. Scant evidence was presented to establish what the efforts to come into compliance using existing staff consisted of, however. There is no question that there were significant violations of relevant regulations in the areas found during the AHCA surveys concerning quality of patient care, referenced above. It is significant to note, however, that in the years immediately prior to the year of the beginning of the relevant surveys (1991) or, in essence, from 1987 through 1990, the Crestview facility enjoyed a superior or standard rating with the same numerical staff complement. This indicates that a great deal of inadequacies in quality of patient care resulted from personnel management and operational management problems at the facility, rather than merely that the staff in the relevant nursing positions was numerically inadequate. Corollarily, it is equally noteworthy that no inadequacies in numbers of staff and the required staff positions was noted by the surveyors. Crestview, both before the surveys were made and during the surveys, was staffed with more than the minimal staffing requirements and staff positions provided for in Title 10D, Florida Administrative Code. It thus cannot be found that all of the staff members hired by Crestview in response to the surveys and deficiencies noted by AHCA were necessary to come into compliance with the state and federal laws involved. Some additional staffing was necessary for this purpose however, because of the recent increase in resident population. After the November, 1991 survey by AHCA, Crestview added two licensed practical nurse (LPN) positions in response to the deficiencies cited by AHCA and based upon Ms. Petty's observations. The primary functions of one of the LPNs was to monitor and evaluate restraint use, and the other LPN position was created to address the nutritional status of the residents, including monitoring the dining room, meal intakes, and assuring that dietary supplements were given. These two positions were approved by the agency, as set forth in Mr. Hughes' letter of September 9, 1992. Mr. Hughes is the agency official charged with approving interim rate requests. These two positions were approved September 9, 1992. Crestview added a third nurse position to address the problem of decubitus or "pressure sores" experienced by many residents in the nursing home. This nurse was to monitor the new pressure sore prevention program instituted by Crestview, doing skin observation "rounds" and skin reports. The nursing home had been cited by AHCA for its high decubitus rate and lack of proper treatment of the pressure sores. Ms. Petty opined that the nurse position was needed in order to attend to the significant decubitus rate and to bring the facility into compliance with state and federal laws. Crestview also hired seven certified nursing assistants (CNA). The Department, in granting interim rates, allowed for the equivalent of three of those positions at the cost that Crestview attributed to those positions, as set forth in Mr. Hughes' letter of September 9, 1992. That cost represents the cost for hiring such personnel at the contract nursing pool rate obtainable through the nursing home operation consulting firm which Crestview retained and paid and for which expense it also sought interim rate reimbursement increases. In fact, the amount allowed for three such positions and the two nurse positions by the agency, in its free-form decision by Mr. Hughes, would actually pay for all of the positions sought for rate approval by Crestview if they were paid at what Mr. Hughes established to be a reasonable cost level, meaning what a "prudent and cost- conscious buyer" seeking to hire such personnel in the nursing home industry would typically pay for such a given service. The seven CNA positions were created by Crestview to provide the resident care services and functions depicted in paragraphs 13-16 of the Petitioners' proposed findings of fact and shown by Ms. Petty's testimony. Crestview maintains that these positions were created so as to bring the facility into compliance with the state and federal laws addressing the various quality of care deficiencies for which the facility was cited by AHCA. It was not proven, however, for the reasons found above, that, indeed, all of those positions were necessary in order to bring the facility into such compliance. It has not been demonstrated by a preponderance of the evidence that the five equivalent positions approved by the Department for Crestview would not have been sufficient to bring the facility into compliance with existing state or federal laws, rules or standards. In fact, sufficient evidence was not adduced to establish that proper performance by the director of nursing, in supervising personnel and operations of the facility, by the facility's administrator, and the entity owning and managing the facility, could not have brought the facility into compliance with pertinent laws and standards with little or no additional staff. The facility had enjoyed superior or standard ratings without the additional staff in the years immediately prior to the year in which the problems were found. In any event, Mr. Hughes's testimony, and to some extent, that of Ms. Gonzales, as well as the testimony of the Petitioner's witnesses upon cross- examination, establish that the five position equivalencies approved by the Department would be sufficient to bring Crestview into compliance with pertinent laws and rules, especially in view of the testimony of Mr. Hughes, which is accepted, that the amount approved for the positions would, in reality, fund all ten positions requested if the nursing home hired them at ordinary, reasonable and accepted rates in the industry, rates commonly approved by the medicaid system and plan. Crestview contends that because of the isolated and small labor market for such nursing personnel in the Crestview vicinity, it had to resort to the nursing home consulting firm and "nursing pool" in order to obtain, at the contract costs proposed, the nursing personnel in question. The Petitioners' evidence does not establish that it made significant efforts to hire the personnel itself, at the rates which the Department showed are ordinary and reasonable, without resort to the greater cost attributable to obtaining personnel through the consulting firm and contract nursing labor pool. Consequently, a preponderance of the evidence establishes that the interim rate request approval level determined by the Department in the free-form stage of this dispute is, indeed, an appropriate level under the circumstances established by the evidence of record. This is particularly appropriate because of the finding by the agency, established in this record, that an across-the- board wage increase of over $100,000.00 had been granted its employees by Crestview in the summer of 1992, shortly before the interim rate increase request was submitted. The interim rate increase request was not submitted until Crestview also became liable for significantly-increased costs for contract pool labor, which began to increase in June and July of 1992. In fact, all of the personnel contended by Crestview to be necessary had been hired and on the job since March of 1992 and yet the interim rate increase was not applied for until after the contract labor costs and the wage increases occurred. The agency thus granted an interim rate increase of some $223,000.00 out of approximately $500,000.00 requested, which was shown to cover the cost of ten regularly-compensated personnel of this type, based upon the reasonable cost basis for that kind of labor, as shown by the testimony of Mr. Hughes. The medicaid reimbursement plan only pays "allowable costs", which are those costs shown by Mr. Hughes, which should not exceed what a prudent and cost-conscious buyer would pay for a given service. The Bluffs was cited by the OLC to be deficient under licensure regulations for failing to properly document injuries to various residents and for failing to document decubitus ulcers (pressure sores) and nutritional problems among the nursing home residents. The deficiencies cited did not include any determination by the surveyors that additional staff was needed. Although the deficiencies involved record-keeping errors, whereby The Bluffs was failing to document and track residents with decubitus ulcers and residents with weight-loss problems, if a nursing home is not adequately tracking and recording such problems, then it tends to overlook and fail to adequately treat them. The lack of proper records concerning decubitus ulcers and nutritional deficiency makes it difficult to institute and consistently follow a treatment regimen for the decubitus ulcers and the weight loss problems and a consistently-effective prevention program, involving "skin rounds" and regular "turning" of patients who are unable to turn over in bed. The Bluffs was not cited for failing to treat pressure sores but, rather, for failure to document their presence, which can make it difficult to consistently monitor and treat them. Both before and after the citations, The Bluffs employed a director of nursing who is responsible for ascertaining that residents' injuries, weight loss, or decubitus ulcer problems are documented and that treatment therefor is obtained. Although The Bluffs was not directly cited for failing to maintain good nutritional status or because residents had pressure sores, the testimony of Ms. Petty establishes that the facility was not in compliance with existing state or federal laws, rules or standards in the area of maintaining good nutritional status and insuring that residents were receiving necessary treatment to promote healing and prevention of pressure sores. In the belief that it was unable to correct the deficiencies with its existing staff, The Bluffs hired a registered nurse (RN), an LPN, and a CNA. The CNA position was created to obtain weights and to assist with the feeding, including supplements, to offer alternatives for nourishment to residents, as well as to assist with daily skin rounds and to assist with the "positioning program" in order to bring the facility into compliance in the view of The Bluffs, concerning deficiencies in nutritional care and decubitus care. An LPN position was created in order to take care of the nutritional status of the residents, to assess weight variances in residents, to monitor meal and nourishment intake and also to act as a dining room supervisor. This position was created, according to The Bluffs, in order to bring the facility into compliance with good nutritional status for the residents and to address the problem of pressure sores. The Bluffs also created an RN position, responsible for the pressure sore prevention program and treating existing decubitus. This person makes daily skin rounds on all residents and is responsible for identifying those at risk of developing decubitus and assessing and evaluating the process of healing and notification of physicians if treatment alternatives are needed. This person is also responsible for monitoring the positioning program to make sure that the residents are placed in proper positions and that pressure-relieving devices are employed. This RN also does weekly assessments of pressure sores. In response to the deficiencies cited and those observed by Ms. Petty, there was developed at The Bluffs and Crestview a pressure sore positioning program and a meal monitoring program. There is no doubt, as shown by the testimony of Ms. Petty, that there was a serious problem with the provision of patient and nursing care to the residents at each facility. The Petitioners each were given conditional licenses after the initial inspection and notice of deficiencies. After the addition of the above- mentioned personnel and program corrections The Bluffs has brought its rating up to a standard rating. It will likely achieve a superior rating on its license this upcoming year. Crestview has moved from a conditional rating to a superior rating. The Petitioners maintain that the individuals hired at the facilities were hired prior to the request for an interim rate increase, have been maintained during the time of that increase request and are full-time positions. It was not shown, however, that the positions added at The Bluffs actually were required to be hired in order for the facility to maintain compliance with state or federal laws, rules, and relevant standards. While there is no doubt that the addition of these personnel and the hiring of the quality assurance consulting firm, at $6,000.00 per year, helped bring the two facilities into compliance with existing laws and included the imposition of systems devised by the consulting firm designed to provide training for the staffs, it was not actually demonstrated to be required in order to bring the facilities into compliance. The record reveals, as was the case with Crestview, that The Bluffs enjoyed superior or standard ratings in the years immediately prior to the year when the deficiencies were noted in the survey. It was not demonstrated by preponderant evidence that the standards became significantly more stringent in the year when the deficiencies were found. There is evidence from which an inference can be drawn that the director of nursing and the administration of the nursing home at The Bluffs was not managing and operating the facility correctly and efficiently in terms of nutrition and prevention and treatment of decubitous ulcers. All of these duties, which were assigned to the three new personnel in order to remove the "cloud" on The Bluffs' license, were duties that existing staff were required to perform in the first place. The evidence reveals, given the prior superior ratings, with the same original amount of staff, that had The Bluffs' staff been managed and trained properly, the deficiencies would not have occurred. If there was a problem with individual staff members, including the director of nursing, then those people could be removed from the staff complement, moved to other positions or simply trained and admonished in how to perform their job correctly so as to prevent the referenced deficiencies. It was not shown that the additional staff to correct the deficiencies was actually necessary in order to bring the facility into compliance with relevant law. The additional staff no doubt had that effect; but the extra expense to alleviate the deficiencies by that method, including the fee paid to the consulting firm, was not justified. Consequently, the interim rate increase for The Bluffs should be denied.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence of record, and the candor and demeanor of the witnesses, it is RECOMMENDED that a Final Order be entered denying the interim rate request by The Bluffs Nursing Home and granting a rate increase to Crestview Nursing and Convalescent Center in the amount and in the manner found and concluded above. DONE AND ENTERED this 1st day of April, 1994, in Tallahassee, Florida. P. MICHAEL RUFF Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of April, 1994. APPENDIX TO RECOMMENDED ORDER, CASE NOS. 93-0915 AND 93-1542 Petitioners' Proposed Findings of Fact 1-8. Accepted. Rejected, as subordinate to the Hearing Officer's findings of fact on this subject matter and as not supported by the preponderant evidence of record. Accepted, but subordinate to the Hearing Officer's findings of fact on this subject matter. Accepted, to the extent that it depicts the duties of the additional nurse and Ms. Petty's view of the necessity but subordinate to the Hearing Officer's findings of fact on this subject matter. Accepted, but not to the extent that it is a finding that all seven CNAs were necessary. 13-16. Accepted, to the extent that these findings of fact depict what the duties of the personnel hired were, but not to the extent that it establishes that all were necessary to bring the facility into legal compliance. Rejected, as subordinate to the Hearing Officer's findings of fact on this subject matter and as not being supported by the preponderant evidence of record. Accepted. Rejected, as not being supported by the preponderant evidence of record. 20-24. Accepted, but not to the extent that it is found that the positions were actually necessary in order to bring the facility into legal compliance. Rejected, as contrary to the preponderant weight of the evidence and the Hearing Officer's findings of fact on this subject matter. Rejected, as contrary to the preponderant weight of the evidence and subordinate to the Hearing Officer's findings of fact on this subject matter. Accepted, but not itself dispositive of any material issues. 28-30. Accepted. 31. Rejected, as not being in accordance with the preponderant weight of the evidence. 32-33. Accepted. Rejected, as subordinate to the Hearing Officer's findings of fact on this subject matter and not entirely supported by the preponderant evidence of record. Accepted, as to the motivation of the nursing home administration in terms of why the hiring was done but not to the extent that it is agreed by the Hearing Officer that the hiring was necessary. Accepted. Rejected, as contrary to the preponderant weight of the evidence and the Hearing Officer's findings of fact on this subject matter. Rejected, as contrary to the preponderant weight of the evidence and subordinate to the Hearing Officer's findings of fact on this subject matter. 39-40. Accepted. 40-48. Accepted, but not necessarily as to the material import advanced by the Petitioners. 49. Rejected, as subordinate to the Hearing Officer's findings of fact on this subject matter. Respondent's Proposed Findings of Fact 1-22. Accepted, but subordinate to the Hearing Officer's findings of fact on this subject matter. 23-33. Accepted. COPIES FURNISHED: Jonathan S. Grout, Esquire GOLDSMITH & GROUT, P.A. 307 West Park Avenue Post Office Box 1017 Tallahassee, Florida 32302-1017 Gordon B. Scott, Esquire Agency for Health Care Administration 1317 Winewood Boulevard Building Six, Room 271 Tallahassee, Florida 32399-0700 Sam Power, Agency Clerk Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303 Harold D. Lewis, Esquire General Counsel Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303
Findings Of Fact The Petition named Dr. Szurkus as the physician providing obstetric services at Desmond’s birth on February 14, 2009. Attached to the Motion for Summary Final Order is an affidavit of NICA's custodian of records, Tim Daughtry, attesting to the following, which has not been refuted: One of my official duties as Custodian of Records is to maintain NICA’s official records relative to the status of physicians as participating physicians in the Florida Birth-Related Neurological Compensation Plan who have timely paid the Five Thousand Dollar ($5,000.00) assessment prescribed in Section 766.314(4)(c), Florida Statutes, and the status of physicians who may be exempt from payment of the Five Thousand Dollar ($5,000.00) assessment pursuant to Section 766.314(4)(c), Florida Statutes. Further, I maintain NICA's official records with respect to the payment of the Two Hundred Fifty Dollar ($250.00) assessment required by Section 766.314(4)(b)1., Florida Statutes, by all non-participating, non-exempt physicians. * * * As payments of the requisite assessments are received, NICA compiles data in the “NICA CARES” database for each physician. The “NICA CARES physician payment history/report” attached hereto for Dr. Dennis Szurkus indicates that on February 14, 2009, the date in which Dr. Szurkus participated in the delivery of Desmond Govan, as indicated in the Petitioner’s Petition for Benefits, Dr. Szurkus did not pay the Five Thousand Dollar ($5,000) assessment required for participation in the Florida Birth-Related Neurological Injury Compensation Plan until September 21, 2009. Further, it is NICA’s policy that if a physician falls within the exemption from payment of the Five Thousand Dollar ($5,000) assessment due to their status as a resident physician, assistant resident physician or intern as provided in Section 766.314(4)(c), Florida Statutes, annual documentation as to such exempt status is required to be provided to NICA. NICA has no records with respect to Dr. Szurkus in relation to an exempt status for the year 2009. The physician payment history/report for Dr. Szurkus supports Mr. Daughtry’s affidavit. Petitioner has not offered any exhibits, affidavits or any other evidence refuting the affidavit of Mr. Daughtry, which shows that on February 14, 2009, Dr. Szurkus had not paid his $5,000 assessment for 2009. At the time of the birth of Desmond, Dr. Szurkus was not a participating physician in the Plan.
Findings Of Fact The parties stipulated during the course of the formal hearing in this cause that the adjustments made by Respondent to Petitioner's Medicaid cost report for the fiscal year ending June 30, 1981, were the same as the adjustments made by Respondent to Petitioner's Medicaid cost report for the fiscal year ending June 30, 1980. They therefore presented evidence and arguments on the adjustments made for 1980 with the stipulation that if Petitioner prevailed regarding any item which was adjusted for 1980, then that item would automatically be so adjusted for 1981. The parties further stipulated that the cost item "return on equity" is merely a function of the other proposed adjustments and, therefore, if the Petitioner prevailed on other disputed adjustments herein, then "return on equity" would be automatically revised to reflect an increase. Respondent proposed an adjustment to Petitioner's Medicaid cost report for the fiscal year ending June 30, 1980, in the amount of $15,223 for short- term liabilities. At the commencement of the formal hearing, Respondent withdrew its adjustment to that item and stipulated that Petitioner was correct in its position. Accordingly, that portion of the dispute has been withdrawn from consideration herein. Petitioner claimed $5,191 as the advertising cost for Hollywood Hills Nursing Home in the fiscal year ending June 30, 1980, which amount represents the cost of a large, yellow pages advertisement in the Southern Bell Telephone Directory. Respondent disallowed all Southern Bell advertising cost except for the sum of $178.20, which represents the cost of a simple alphabetical listing in the yellow pages. The advertisement in question is excessive in size and primarily consists of the name of the facility, a reproduction of the facility's logo, a picture of the facility, and a picture of a very happy couple. The ad is not primarily informational but rather is clearly promotional and intended to increase patient utilization. Accordingly, Respondent properly, disallowed this cost item and properly allowed the cost of a simple alphabetical listing, the norm in the nursing home industry at the time. In the fiscal year ending June 30, 1980, Petitioner included in its cost report the sum of $37,147.18 representing the "Herlee consulting fee," and Petitioner further claimed a similar amount as a cost item in its 1981 report. Respondent disallowed this reported home office cost. This cost includes salaries for Herbert and Leonore Kallen and other allocated expenses of the "home office" such as rent, automobiles, utilities, insurance, depreciation and amortization thereof, legal fees, and outside consulting fees. Respondent disallowed all Herlee expenses. The Kallens own three health care providers which are located in two facilities, to wit: Hollywood Hills Nursing Home and Hollywood Pavilion Psychiatric Hospital located in the same facility in Hollywood, Florida; and Norwichtown Convalescent Home located in Norwichtown, Connecticut. Contracts were entered into on behalf of these providers whereby they would be managed by Herlee Management Company, another of the Kallens' corporations. Although Herlee, Inc., was formed to manage the Kallens' two physical facilities under the "chain organization" provisions of the health insurance manual, none of the Herlee or home office costs are proper. No documents reflect the proportion of the Kallens' time which is spent in managing Hollywood Hills Nursing Home. Petitioner's evidence ranges from the Kallens spending an approximate 12.5 percent of their time to them spending an approximate 75 percent of their time related to Petitioner. The evidence is simply not credible. No time sheets exist; likewise, no records exist regarding any duties performed at any particular time. Rather, both the administrator and the "executive manager" of Hollywood Hills Nursing Home are full-time employees of Herlee Management Corporation, both of whom were capable of performing and did perform all of the duties alleged to have been performed by the Kallens at unknown times. The Herlee home office cost/Herlee consulting fee is not documented, is not reasonable, is duplicitous rather than necessary, and is not related to any patient care. Any time spent by the Kallens in the management of Hollywood Hills Nursing Home, if any, was spent merely as a protection of their financial investment. In further support of the lack of documentation to substantiate this cost item, it is noteworthy that Petitioner's witnesses did not even agree on the location of the Kallens' home office. Respondent properly disallowed the Herlee cost items as to the Kallens and properly allowed only that portion of the cost which related to the salary and benefits paid to the full-time employee of Herlee who also served as the nursing home administrator. The Kallens acquired Hollywood Hills Nursing Home through a purchase of stock rather than through a purchase of assets. Petitioner, therefore, took its vendor's basis for depreciation purposes directly from the books of its predecessor. When the audit of 1980 and again of 1981 revealed that Petitioner had no documentation on which to substantiate the basis used for depreciation, Respondent could have disallowed all property costs. Rather than doing so and possibly forcing Petitioner out of the Medicaid program or out of business, Respondent utilized the next best source of information, a 1969 appraisal indicating a verified construction cost, although utilizing that appraisal was admittedly a departure from normal audit procedures. The deviation from normal auditing principles is proper in this situation where Petitioner could provide no documentation to substantiate its basis for depreciation, and the appraisal provided estimates of cost at the time the facility was constructed. The adjustments made by Respondent for both 1980 and 1981 were therefore proper. Petitioner claimed $7,844 as an amortization expense for the fiscal year ending June 30, 1980, and $6,747 as the amortization expense for the fiscal year ending June 30, 1981. Amortization expense is the cost of acquiring the original mortgage on the facility and is a legitimate and recognized expense which is reimbursable under Medicaid regulations. Respondent totally disallowed Petitioner's claimed amortization expense since Petitioner possesses no data showing the actual cost of financing. Petitioner also failed to present any evidence as to when the Kallens purchased the facility, as to when the mortgage was placed on the facility, and as to whether the Kallens assumed a prior mortgage or obtained their own financing. Accordingly, Respondent properly disallowed the amortization expense in both Petitioner's 1980 and 1981 cost reports. Respondent had made a total adjustment for non-legend drugs in the amount of $15,244 for 1980 and 1981 combined. At the formal hearing, counsel requested an opportunity to attempt to work out an independent solution to this adjustment in order to remove that adjustment from consideration herein. The parties have agreed posthearing that $11,185 out of the Respondent's $15,244 adjustment should be disallowed and overpayment deductions by Respondent have been erroneous. Accordingly, Petitioner is entitled to receive from the Respondent the amount of $11,185 representing this non-legend drugs item.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that a Final Order be entered upholding Respondent's adjustments to Petitioner's Medicaid cost reports for the fiscal years ending June 30, 1980, and June 30, 1981, as to advertising, the Herlee consulting fee/home office costs, depreciation, and amortization; making any adjustment necessary as to Petitioner's return on equity; withdrawing Respondent's adjustment for short- term liabilitites for 1980; and memorializing the terms of the parties' stipulation as to non-legend drugs. DONE and RECOMMENDED this 4th day of April, 1984, in Tallahassee, Leon County, Florida. LINDA M. RIGOT, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4th day of April, 1984. COPIES FURNISHED: Howard Todd Jaffe, Esquire 1915 Harrison Street Hollywood, Florida 33020-5098 Jay Adams, Esquire Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301 David H. Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Recommendation Based upon the findings of fact and conclusions of law recited above, it is recommended that respondent's decision to deny petitioner's capital expenditure proposal to lease the Cambridge Nursing Home in New Port Richey be AFFIRMED. Respectfully submitted and entered this 9th day of September, 1977, in Tallahassee, Florida. DIANE D. TREMOR, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Art Forehand, Administrator Office of Community Medical Facilities Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301 Frank M. Gafford, Esquire Post Office Box 1789 Lake City, Florida 32055 Chriss Walker, Esquire Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact The Amended Petition named Dr. Tracey Molrine as the physician providing obstetric services at Eileen’s birth on August 30, 2014. Attached to the Motion for Summary Final Order is an affidavit of NICA's custodian of records, Tim Daughtry, attesting to the following, which has not been refuted: One of my official duties as Custodian of Records is to maintain NICA’s official records relative to the status of physicians as participating physicians in the Florida Birth-Related Neurological Compensation Plan who have timely paid the Five Thousand Dollar ($5,000.00) assessment prescribed in Section 766.314(4)(c), Florida Statutes, and the status of physicians who may be exempt from payment of the Five Thousand Dollar ($5,000.00) assessment pursuant to Section 766.314(4)(c), Florida Statutes. Further, I maintain NICA's official records with respect to the payment of the Two Hundred Fifty Dollar ($250.00) assessment required by Section 766.314(4)(b)1., Florida Statutes, by all non-participating, non-exempt physicians. * * * As payments of the requisite assessments are received, NICA compiles data in the “NICA CARES” database for each physician. The “NICA CARES physician payment history/report” attached hereto for Dr. Tracey Molrine [sic] indicates that in the year 2014, the year in which Dr. Molrine [sic] participated in the delivery of Eileen Mares, as indicated in the Petitioners’ Petition for Benefits, Dr. Morline [sic] did not pay the Five Thousand Dollar ($5,000) assessment required for participation in the Florida Birth- Related Neurological Injury Compensation Plan. Further, it is NICA’s policy that if a physician falls within the exemption from payment of the Five Thousand Dollar ($5,000) assessment due to their status as a resident physician, assistant resident physician or intern as provided in Section 766.314(4)(c), Florida Statutes, annual documentation as to such exempt status is required to be provided to NICA. NICA has no records with respect to Dr. Molrine [sic] in relation to an exempt status for the year 2014. To the contrary, the attached "NICA CARES physician payment history/report shows that in 2013 [sic], Dr. Molrine [sic] paid the Two Hundred and Fifty Dollar ($250) assessment required by Section 766.314(4)(b)1., Florida Statutes, for non-participating, non-exempt licensed physicians. The physician payment history/report for Dr. Tracey supports Mr. Daughtry’s affidavit. Petitioners acknowledge in their Motion in Partial Support of Respondent’s Motion for Final Summary Order that the requirement of section 766.309(1)(b), that obstetric services be provided by a participating physician, has not been satisfied. At the time of the birth of Eileen, Dr. Tracey was not a participating physician in the Plan.
