The Issue Whether Respondent should refuse to renew Petitioner's medical license on the ground that Petitioner has been terminated for cause from the Florida Medicaid program, as Respondent has indicated it intends to do.
Findings Of Fact Based on the evidence adduced at hearing, and the record as a whole, the following findings of fact are made: Petitioner is a Florida-licensed medical doctor seeking the renewal of her license. She used to participate as a provider in the Florida Medicaid program. On May 12, 2003, the Agency for Health Care Administration (AHCA) issued a Final Order in Audit No. CI 01- 1713-000, finding that Petitioner received Medicaid overpayments in the amount of $203,059.61, and ordering that she "refund forthwith [that sum] together with such statutory interest as is set forth in § 409.913(24)(b), Florida Statutes." On June 13, 2003, Petitioner filed a motion requesting that ACHA's May 8, 2003, Final Order, be set aside. AHCA denied the motion by Order dated November 18, 2003. Not having received from Petitioner the monies she was ordered to pay, AHCA sent Petitioner a letter, dated May 30, 2008, advising her that it intended to fine her $5,000.00 for having failed to pay her "outstanding debt that [was] owed to [ACHA], related to a Medicaid overpayment"; that "[i]f payment [was] not received or arranged for, within 30 days of receipt of this letter, [AHCA] [might] withhold Medicaid payment"; and that "failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by [AHCA] [might] result in additional sanctions, which [could] include, but [would] not [necessarily be] limited to, fines, suspension, and termination from the Medicaid Program." AHCA's May 30, 2008, letter also contained a Notice of Administrative Hearing and Mediation Rights. By letter dated August 13, 2008, AHCA advised Petitioner that it was "suspending [her] participation in the Medicaid program" due to her still having an "outstanding debt . . . owed to [AHCA]" and that "continued non-compliance [would] result in this suspension converting to termination from participation in the Medicaid program in accordance with Rule 59G-9.070, F.A.C." AHCA's August 13, 2008, letter also contained a Notice of Administrative Hearing and Mediation Rights. On June 11, 2009, Horace Dozier, the Field Office Manager in AHCA's Office of the Inspector General, Medicaid Program Integrity, sent Petitioner a letter, which read as follows: Our records indicate that on August 13, 2008 the Agency for Health Care Administration (Agency) issued a final agency action letter imposing a sanction for an outstanding debt that is owed to the Agency. The letter further informed you that, in accordance with Section 409.913, Florida Statutes (F.S.), and Rule 59G-9.070, Florida Administrative Code (F.A.C.), continued non- compliance would result in termination from the Medicaid program. As such, the Agency is hereby terminating your participation in the Medicaid program. This includes any action that results in a claim for payment to the Medicaid program as a result of furnishing, supervising a person who is furnishing, or causing a person to furnish goods or services. This will take effect immediately. You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. If a request for a formal hearing is made, the petition must be made in compliance with Section 28-106.201, F.A.C. and mediation may be available. If a request for an informal hearing is made, the petition must be made in compliance with rule Section 28-106.301, F.A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this letter. For more information regarding your hearing and mediation rights, please see the attached Notice of Administrative Hearing and Mediation Rights. Any questions you may have about this matter should be directed to: Horace Dozier, Field Office Manager, Agency for Health Care Administration, Medicaid Program Integrity . . . . The last paragraph of the "attached Notice of Administrative Hearing and Mediation Rights" to which Mr. Dozier referred in his letter read as follows: 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 [sic] shall be conclusive and final. Notwithstanding the assertion made in the last sentence of the first paragraph of the body of Mr. Dozier's June 11, 2009, letter that "[t]his will take effect immediately," the determination to terminate Petitioner from the Medicaid program for nonpayment of an "outstanding debt . . . owed to [AHCA]" was treated by AHCA (appropriately, and consistent with the last paragraph of the "attached Notice of Administrative Hearing and Mediation Rights") as merely "intended action" that had not yet ripened into final agency action. Petitioner requested an administrative hearing on this "intended action," but she subsequently, on or about November 12, 2009, withdrew her request by filing with ACHA a Withdrawal of Motion for Formal Hearing and Mediation. On February 16, 2010, ACHA (through its Secretary) issued its Final Order terminating Petitioner from the Florida Medicaid program. The body of AHCA's Final Order provided as follows: THIS CAUSE is before me for issuance of a Final Order on a Final Agency Action Letter dated June 11, 2009 (C.I. # 087796000). By . . . Letter, the Agency for Health Care Administration ("AHCA" or "Agency") informed the Petitioner, Trinidad Rojas, M.D., (hereinafter "PROVIDER"), that the Agency was terminating the PROVIDER from the Medicaid Program pursuant to Section 409.913 and Rule 59G-9.070 for non-compliance of payment [of] an outstanding debt owed to the Agency for overpayments (Final Order Rendered May 12, 2003 and Final Order Rendered June 15, 2007) and a fine sanction of $5000.00.[2] The Letter provided full disclosure and notice to the PROVIDER of procedures for requesting an administrative hearing to contest termination. The PROVIDER filed a petition with the Agency requesting an administrative hearing on July 13, 2009. This petition was dismissed without prejudice on July 16, 2009. On August 1, 2009, PROVIDER filed an amended petition, which was forwarded to the Division of Administrative Hearings ("DOAH") by the Agency on August 12, 2009. On November 12, 2009, PROVIDER filed a Withdrawal of Motion for Formal Hearing and Mediation with the Division of Administrative Hearings. Based on Petitioner's Withdrawal of Motion for Formal Hearing and Mediation, the ALJ issued an Order Closing File, cancelled the hearing scheduled for November 17, 2009, and relinquished jurisdiction to the Agency on November 13, 2009.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that a final order be issued refusing to renew Petitioner's medical license. DONE AND ENTERED this 31st day of May, 2011, in Tallahassee, Leon County, Florida. S STUART M. LERNER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 31st day of May, 2011.
The Issue The issue presented at the final hearing was whether the Respondents' Eddy and Edith Portillo pharmacy permit should be revoked or suspended for the acts of a licensed pharmacist hired by the Respondents who engaged in unprofessional and bad faith dispensing of methaqualone as alleged in the Administrative Complaint filed May 26, 1982. John McDonough, a Department medical investigator, John Statnik, a community pharmacist and licensed pharmacist, and Sidney Simkovitz, a retired pharmacist, testified for the Petitioner. Petitioner's Exhibits 1-3 were offered and admitted into evidence. The Respondent Eddy Portillo testified on his own behalf and Respondents' Exhibit 1 was admitted as a late-filed exhibit. A proposed Recommended Order has been submitted by the Petitioner. To the extent that the proposed findings submitted by Petitioner are not reflected in this Order, they were rejected as being either not supported by the weight of admissible evidence or as being irrelevant to the issues determined here.
Findings Of Fact The Respondents Eddy and Edith Portillo hold pharmacy permit number 7276 for Federgo Discount Center, which is located at 1881 79th Street Causeway, North Bay Village, Miami Beach, Florida. Federgo Discount Center is a discount dry goods facility housed in a building of approximately 3,000 square feet. A small portion of the store is occupied by a pharmacy. The Respondent Eddy Portillo is the manager of the entire facility. Since Portillo was not a licensed pharmacist, he hired Michael Interess, a state licensed pharmacist, to operate the pharmacy portion of the store. Pursuant to a "contract work agreement" executed between the Respondent Eddy Portillo and Interess, net profits from the operation of the pharmacy were divided 40 percent to the pharmacist and 60 percent to the store following the deduction of certain delineated items from gross profits. In effect, the pharmacist's wages were based on his success in operating the pharmacy since he was not paid any guaranteed wage. A drug diversion audit conducted by the Petitioner established that the following amounts of methaqualone were dispensed by the pharmacy: November 1, 1981 through February 15, 1982; 56,386 Methaqualone dispensed. June 1, 1980 through February 15, 1982; 251,230 Methaqualone dispensed. When compared to all other Schedule II drugs dispensed by the pharmacy, the percentage of methaqualone dispensed during the audit period was 76.96 percent. No evidence was presented concerning the amount of methaqualone as a percentage of total prescription sales. Based on a seven-day week, approximately 14 methaqualone prescriptions were filled every day of the audit period by the pharmacy. As manager and cashier of the center, the Respondent Eddy Portillo spent a considerable amount of time within the store. The Respondent Portillo received a daily log of all drug sales which indicated the amount of sales in order to compensate Interess, the pharmacist. Although the Respondent Eddy Portillo knew the pharmacy was filling methaqualone prescriptions, he believed the percentage of methaqualone dispensed to be reasonable in relation to total prescription sales. The pharmacy received a large number of methaqualone prescriptions due to its geographical proximity to physicians who apparently frequently prescribed this drug.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered by the Board of Pharmacy dismissing the Administrative Complaint against the Respondents. DONE and ORDERED this 17th day of June, 1983, in Tallahassee, Florida. SHARYN L. SMITH, 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 17th day of June, 1983.
Findings Of Fact At all times relevant thereto, respondent, Manuel M. Maralit, held medical doctor license number ME 0033337 issued by petitioner, Department of Professional Regulation, Board of Medical Examiners. Maralit has been licensed as a medical doctor by the State of Florida since September 13, 1978. He has been a medical doctor since graduation from medical school in May, 1967. From January 1, 1983 through September 30, 1983, Maralit practiced medicine in Alachua County, Florida. During that period of time, he filed two unauthorized claims under the Florida Medicaid Program, each having an aggregate value of $200 or more in violation of Subsection 409.325(4)(a), Florida Statutes. He also received one unauthorized payment under the same program having an aggregate value of more than $200.00 in violation of Subsection 409.325(4)(c), Florida Statutes. After an information was filed by the State Attorney on December 13, 1983, Maralit pled guilty to the above three violations, and to a fourth charge of grand larceny. For this, he received twenty years probation, 2,000 hours of community service, a $15,000.00 fine to be paid within 12 months, and was required to make restitution of $2,398.51 to the Department of Health and Rehabilitative Services and $921.00 to the Florida National Bank. According to the official records of petitioner introduced into evidence, Dr. Maralit was subject to prior disciplinary action by the Medical Board in 1982 (DOAH Case No. 81-1367, Final Order entered January 4, 1982). At that time his license was suspended for thirty days, and was placed on probation for one year. The probationary period has long since expired. The violations in that proceeding are not similar in any respect to those charged in this case. There is no evidence as to any damage, physical or otherwise, to specific patients caused by respondent's conduct.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that respondent be found guilty as charged in Counts I and II of the administrative Complaint, and that his medical license be suspended for one year with six months' suspension stayed and his license be placed on three years probation. Count III should be dismissed. DONE and ORDERED this 4th day of December, 1985, in Tallahassee, Florida. DONALD R. ALEXANDER 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 December, 1985.
Findings Of Fact Respondent holds community pharmacy permit number 0007857, which is issued for the location of 7121 West Flagler Street, Miami, Florida 33144. Filimon Galo is the president, and Miriam Galo is the secretary of Gamy Discount Pharmacy, Inc. On December 9, 1985 and on December 11, 1985, investigators for the Department of Professional Regulation conducted a routine pharmacy inspection of Gamy Discount Pharmacy, Inc. They re-inspected Respondent on January 22, 1986. During each of those inspections, Respondent's prescription department was unclean, unsanitary, and overcrowded. During those inspections, the investigators located several outdated medications in the prescription department. Those medications seized on January 22, 1986, bore expiration dates more than 4 months prior to the date of that inspection. Those medications which were seized by Petitioner contained medicinal drugs and are also known as pharmaceuticals. During the January inspection Respondent had no sign displayed stating the hours when the prescription department is open. During each of Petitioner's inspections, the pharmacy had no sign posted concerning generically equivalent drugs. There was no negative drug formulary in the pharmacy at the time of the inspections. On January 22, 1986, the investigators found one container of a prescription drug--prolizin, a medicinal drug-- which was located outside of the prescription department. During the January inspection, no pharmacist was employed at Respondent's pharmacy. During the January inspection, one vial was seized which bore a handwritten label stating "Diabinol." This vial actually contained a generic equivalent of Diabinol. The vial was misbranded in that it was false or misleading by being labeled with the "brand name" instead of the generic name and did not contain the name and place of business of the manufacturer. During the January inspection, a second vial was located which bore no label. This vial contained a medicinal drug Tranxene and was misbranded in that it did not contain the name and place of business of the manufacturer. During the inspections, prescriptions for controlled substances were discovered which did not contain the name and address of the person for whom the controlled substance was dispensed, the initials of the pharmacist filing the prescription, or the date on which the prescription was filled. During the inspections, Respondent pharmacy had no current drug compendium.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, therefore, RECOMMENDED that a Final Order be entered revoking Respondent's community pharmacy permit. DONE and RECOMMENDED this 19th day of December, 1986, at Tallahassee, 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 19th day of December, 1986. COPIES FURNISHED: Rod Presnell, Executive Director Board of Pharmacy 130 North Monroe Street Tallahassee, Florida 32301 Bruce D. Lamb, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Enrique Miranda, Esquire 2542 SW 6th Street Miami, Florida 33135 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Wings S. Benton, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Conclusions 1. The STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), was notified by Centers of Medicare & Medicaid Services that the Medicare billing number for the above-referenced provider was revoked April 28, 2010. 2. In accordance with Section 409.913(14) if a provider has been suspended or terminated from participation in the Medicaid program or the Medicare program by the Federal Government or any other state, the agency must immediately suspend or terminate, as appropriate, the provider’s participation in the Florida Medicaid program for a period of no less than that imposed by the Federal Government or any other state, and may not enroll such provider in the Florida Medicaid program while such foreign suspension or termination remains in effect. 3. On April 13, 2012, AHCA issued a letter to Respondent, terminating the Respondent’s participation in the Medicaid program. See ATTACHMENT A. AHCA v. C.A.D.C. Corp., d/b/a Miracle Rehab Center (C.1. No: 12-2049-000) Final Order — Page 1 of 4 Filed September 25, 2012 3:12 PM Division of Administrative Hearings A & 33 4. On May 14, 2012, C.A.D.C. CORP., d/b/a MIRACLE REHAB CENTER, (“Respondent”), filed The Request for a Formal Hearing concerning Miracle Rehab Center, with the Division of Administrative Hearings. See ATTACHMENT B. 5. On June 18, 2012, Respondent received a favorable CMS revocation appeal decision. As such, the underlying cause of action which precipitated Florida Medicaid to terminate Respondent is moot, or the revocation was overturned on appeal. See ATTACHMENT C. 6. On July 12, 2012, AHCA issued a letter to Respondent, rescinding the sanctions in the above-styled matter. See ATTACHMENT D. 7. Based on the foregoing, this file is hereby CLOSED. DONE AND ORDERED on this ao* day of opheol , 2012, in Tallahassee, Florida. ; lizabeth ee Secretary Agency for Health Care Administration AHCA v. C.A.D.C. Corp., d/b/a Miracle Rehab Center (C.1. No: 12-2049-000) Final Order — Page 2 of 4 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: Christopher A. Parelia, Qualified Representative The Health Law Offices of Anthony C. Vitale, P.A. 2333 Brickell Avenue Suite A-1] Miami, Florida, 33129 Telephone: (305) 358-4500 Facsimile: (305) 358-5113 Email: CParrella@vitalehealthlaw.com (Via Facsimile and Email) Tracie L. Hardin, Esquire Agency for Health Care Administration 2727 Mahan Drive Building 3, Mail Station 3 Tallahassee, Florida 32308 (Interoffice Mail) Agency for Health Care Administration Bureau of Finance and Accounting 2727 Mahan Drive Building 2, Mail Station 14 Tallahassee, Florida 32308 (Interoffice Mail) Bureau of Health Quality Assurance 2727 Mahan Drive, Mail Stop 9 Tallahassee, Florida 32308 (Interoffice Mail) Mike Blackburn, Bureau Chief Medicaid Program Integrity 2727 Mahan Drive Building 2, Mail Station 6 Tallahassee, Florida 32308 (interoffice Mail) Eric W. Miller, Inspector General Medicaid Program Integrity 2727 Mahan Drive Building 2, Mail Station 6 Tallahassee, Florida 32308 (Interoffice Mail) Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Via U.S. Mail) Florida Department of Health Medical License #299992712 (Via Email Only) AHCA v. C.A.D.C. Corp., d/b/a Miracle Rehab Center (C.1. No: 12-2049-000) Final Order — Page 3 of 4 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by facsimile and email, or the method designated, on this the Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 412-3630 AHCA vy. C.A.D.C. Corp., d/b/a Miracle Rehab Center (C.1, No: 12-2049-000) Final Order — Page 4 of 4
