Findings Of Fact Respondent corporation owns and operates The Ambrosia Home (the Home), a nursing home in Tampa, Florida. Ella Mae Smith, the sole stockholder and the chief executive officer of the corporation, worked as nursing home administrator for the Home from January 1, 1976, through April 21, 1976. Ms. Smith, who is a registered nurse, has been associated with the Home since 1962. On April 22, 1976, Willard Roth began as the Home's administrator, a job he kept through December 31, 1976. In January of 1976, respondent opened a 23 bed addition. Until Mr. Roth's arrival, Ms. Smith worked every day from seven in the morning till seven in the evening, except Saturdays and Sundays when she worked from seven in the morning till three in the afternoon. After Mr. Roth took over as nursing home administrator, Ms. Smith only worked eight hour days although she came back nights occasionally to look in on patients; she stopped going to get supplies for the Home herself and began sharing with Mr. Roth responsibilities for hiring and firing and for finances. For the first three quarters of 1976, respondent employed Judith Irene Roberson as a bookkeeper and secretary at the rate of three dollars an hour. Ms. Roberson is Ella Mae Smith's daughter. For the final thirteen weeks of 1976, Ms. Roberson worked as activities' director for respondent at the rate of three and a half dollars an hour. In both positions, Ms. Roberson worked overtime without pay. Because of this and because of her work for respondent in various capacities in 1970, 197, 1972, 1973, 1974 and 1975, she received a nine thousand dollar ($9,000.00) bonus in 1976. Ms. Roberson began working for respondent in July of 1970. In January of 1976, respondent received payments from petitioner for November and December of the preceding year. This money was used, in March of 1976, to open a savings account at First Federal of Tarpon Springs. In October of 1976, part of the money in the First Federal account was used to open a savings account at the Barnett Bank of Tampa. At no time during 1976, did the balance in the First Federal account fall below thirty-nine thousand, three hundred ninety-four dollars and seventy-six cents ($39,394.76). At no time during 1976, did the balance in the Barnett account fall below twelve thousand nine hundred sixty-four dollars and fifty-one cents ($12,964.51). The following year respondent used the money to pay back taxes, to pay bonuses and for other business purposes. On April 1, 1975, Ms. Smith acquired from respondent corporation the property on which the Home is located. During the year 1976, Ms. Smith leased the property back to the corporation at an annual rent of sixty-thousand dollars ($60,000.00). Rental payments under this agreement were subject to a four percent sales tax. At the close of 1976, there remained owing to Ms. Smith accrued bit unpaid rent. The corporations held a note from Ms. Smith during the year 1976, which she had given as partial payment for the property. In addition, Ms. Smith was indebted to the corporation for mortgage payments it had made on her behalf, aggregating thirty-five thousand six hundred ninety-seven dollars ($35,697.00). During the year 1976, Ms. Smith drove a 1975 Buick to and from work and used the car for other personal purposes. In addition to the personal use she made of the car, she used it to take resident of the Home on picnics, to entertain them in other ways, to transport them to a doctor's office and sometimes to take them to buy clothes. In operating the Home, she used the car for other errands: taking curtains to be cleaned and retrieving them; going shopping for fabric; and weekly trips to a Kwik-Chek store for housekeeping and other supplies. Fuel and maintenance expenses in the approximate amount of eleven hundred dollars ($1,100.00) were incurred in the operation of the automobile during 1976. No records were kept to reflect what fraction of the car's use was personal to Ms. Smith, however. Whenever Ms. Smith purchased supplies for the Home at the Kwik-Chek store, she paid with a check drawn on a Home account. In addition to housekeeping supplies, she sometimes bought Band-Aids and food on these trips. No records were kept to reflect just what was acquired on each trip. According to respondent's records, housekeeping supply expenses aggregated four thousand five hundred sixty-four dollars ($4,564.00) for 1976, and approximately forty- five hundred dollars ($4,500.00) for 1975. During 1976, six hundred dollars ($600.00) were reported stolen from petty cash in two accounts of which respondent had control. Respondent incurred certain legal and advertising expenses aggregating nine hundred fifty dollars ($950.00) in i976. Petitioner reimburses medicaid providers like respondent for a portion of certain expenses they incur in caring for eligible patients. In addition, petitioner's payments to medicaid providers include a return of approximately ten percent to medicaid providers on net assets devoted to the care of eligible patients. Respondent was slated to be audited by petitioner during 1977, in accordance with federal regulations prescribing such audits for each medicaid provider at lease once every three years. Petitioner performed its audit of respondent for the year 1976 earlier in 1977 than it would have otherwise, at the request "of HRS counsel because of a lawsuit that Ambrosia Home" (T48) brought against petitioner. Jesus A. Martinez, an auditor II in petitioner's employ, performed the audit of respondent, which was subsequently reviewed by Messrs. Roark and Conners, and possibly by Mr. Powell, all of whom are also employees of petitioner. As a result of the audit, petitioner proposes to disallow certain expenses claimed by respondent. These include sales tax on rent paid by respondent to Ms. Smith; portions of salaries respondent paid Ms. Smith and Ms. Roberson; petty cash reported stolen; checks to Kwik-Chek in excess of fifty dollars ($50.00), aggregating two thousand five hundred sixty-seven dollars and seventy-eight cents ($2567.78); and expenses related to the 1975 Buick, viz., interest on money borrowed to acquire it, an allowance for depreciation, insurance, taxes, licenses and operating expenses. Petitioner originally proposed to disallow certain professional fees, but indicated after the hearing that it would allow them. On advice that has since been rejected, respondent did not originally claim depreciation and operating expenses for the automobile. Similarly, respondent did not originally include the value of the automobile in computing the equity on which its return should be calculated, but took the contrary position in these proceedings. Petitioner proposes to disallow the value of the automobile and, as a result of the audit, to disallow certain other items respondent included in computing its equity capital. These include funds drawing interest in saving accounts far more than six months and Ms. Smith's obligations to respondent. On the other hand, petitioner included in equity capital the unpaid rent respondent owed Ms. Smith, even though respondent failed to include this item in its equity calculations. The foregoing findings of fact should be read in conjunction with the statement required by Stuckey's of Eastman, Georgia v. Department of Transportation, 340 So.2d 119 (Fla. 1st DCA 1976), which is attached as an appendix to the recommended order.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That petitioner allow the entire salary respondent paid Ms. Smith in 1976, as a reasonable cost. That petitioner allow the salary respondent paid Ms. Roberson in 1976, as a reasonable cost, less and except seven thousand three hundred seventy dollars ($7,370.00). That petitioner disallow and exclude all other disputed items. DONE and ENTERED this 16th day of October, 1978, in Tallahassee, Florida. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 APPENDIX Paragraph one of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraph two of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs three and four of petitioner's proposed findings of fact are consistent with the evidence adduced at the hearing but are not strictly relevant. Paragraph five of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs six and seven of petitioner's proposed findings of fact are actually proposed conclusions of law. Paragraph one of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except that the evidence did not establish when cost reports for the year 1976 were submitted. Paragraph two of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except for the last clause thereof which was not established by the evidence. Paragraph three of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs four and five of respondent's proposed findings of fact are consistent with the evidence adduced at the hearing but are not strictly relevant. Paragraph six of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except for the final sentence thereof, which is not supported by the evidence. Paragraphs seven and eight of respondent's proposed findings of fact have been adopted, in substance, insofar as relevant. Paragraphs nine and ten of respondent's proposed findings of fact are actually proposed conclusions of law. COPIES FURNISHED: Ellen Ostman, Esquire Department of HRS 4000 West Buffalo Avenue Tampa, Florida 33614 Allan M. Dabrow, Esquire Suite 1300 1845 Walnut Street Philadelphia, Pennsylvania 19103 Mr. David Ganley Supervisor of Nursing Home Receivables Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301 Mr. Carl McBride Department of Accounting Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301 The Ambrosia Home 1709 Tallaferro Road Tampa, Florida 33609 W. Kirk Brown, Esquire 313 Williams Street Suite 10 Post Office Box 4075 Tallahassee, Florida 32303
The Issue Whether Petitioner was properly denied home energy assistance.
Findings Of Fact Sometime during October or November, 1982, Petitioner obtained Respondent's application form for home energy assistance, at the Salvation Army office in Ocala, Florida, and subsequently mailed it to the Respondent's Ocala office. She received nothing further about her benefit from Respondent but did nothing about it until March, 1983, when she found out that people that she knew were getting their assistance. Since she had not received hers, she went to Respondent's office and inquired as to what happened. Petitioner was told by an unknown clerk at Respondent's office, who checked the records, that her application had not been received. An application for a different Pamela Perez, who possesses a different Social Security number and a different address had been received. By that time, however, the deadline for filing applications had expired and in fact, the program was being phased out. Petitioner is part of a family of four whose total monthly income would qualify it for benefits had the application been received on time. Respondent would not accept Petitioner's application when she came to their office in March, 1983, as the deadline established for accepting applications was December 27, 1982. Petitioner believes she submitted her application in a self-addressed envelope affixed to the form when she picked it up. No such envelope was affixed to the form by Respondent's personnel. Since Petitioner is not sure of this and Respondent denies furnishing the envelopes, I find that if the application was filed, it was in an envelope provided by Petitioner or someone else.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED: That the Department of Health and Rehabilitative Services deny Petitioner's application for low income energy assistance benefits. RECOMMENDED this 1st day of June, 1983, in Tallahassee, Florida. ARNOLD H. POLLOCK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of June, 1983. COPIES FURNISHED: Pamela Perez 5114 Southeast. County Highway 25 Belleview, Florida 32620 James Sawyer, Esquire District Counsel Department of HRS 2002 Northwest. 13th Street Gainesville, Florida 32601 Honorable David Pingree Secretary, Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
The Issue Whether or not Respondent had cause to revoke Petitioners'1 conditional license to operate a group home facility.
Findings Of Fact Based on the testimony of witnesses presented, the documentary evidence, and Petitioners' Responses to Request for Admissions and the entire record in this proceeding, the following findings of fact are made: Petitioners, John R. Oliver and his father, Otis Clay Oliver, have owned and operated Friendship Group Home for approximately 22 years. From 1995 until about six months before the inspections that resulted in a conditional license and its revocation, they had operated it jointly. Early in 2001, John Oliver became solely responsible for the management of the group home facility. Friendship Group Home is a "group home facility." As defined in Subsection 393.063(24), Florida Statutes, a "'Group home facility' means a residential facility which provides a family living environment including supervision and care necessary to meet the physical, emotional, and social needs of its residents. The capacity of such a facility shall be at least 4 residents but not more than 15 residents." Respondent, Department of Children and Family Services, is authorized by Section 393.067, Florida Statutes, to "provide through its licensing authority a system of provider qualifications, standards, training criteria for meeting standards, and monitoring for residential facilities " In addition to its licensing authority, Respondent may, as authorized by Subsection 393.0673(1), Florida Statutes, ”deny, revoke, or suspend a license or impose an administrative fine, not to exceed $1,000 per violation per day, for a violation of any provision of s. 393.0655 or s. 393.067 or rules adopted pursuant thereto." On March 2, 2002, Bernard "Andy" Anderson, a veteran safety and sanitation inspector employed by the Orange County Health Department (an independent governmental agency that inspects public facilities for sanitation and safety), conducted a routine inspection of Friendship Group Home. Mr. Anderson described the conditions he found as a "hellhole." More specifically, he found that thermostats were needed in all refrigerators; mattresses were soiled and torn; bed linen throughout was very dirty, ripped, and torn, some needed to be replaced, all needed regular cleaning; toilets were dirty, some with feces, all were stained, some needed to be replaced; showers needed cleaning; and some floor tile needed replacement, and cleaning. Mr. Anderson further described the facility as "in need of a lot of work"; "absolute filth in each room of the facility"; it was so dirty that "it was a place he wouldn't want to sit down in"; "there was a stench throughout the building"; and "people that lived there were not clean and taken care of." The facility was rated as "unsatisfactory" and given ten days to make corrections. Upon re-inspection on March 14, 2001, to determine corrections, the facility was determined to be "satisfactory." On April 24, 2001, a fax directed to Laura Lucas in response to a request from Respondent for a copy of a Sanitation Inspection Report, Mr. Anderson commented, "Clay Oliver does just enough to get by me. That place is a hellhole." Mr. Anderson's testimony and the exhibits he authored are believable and accepted by the undersigned as credible. Lois Smith and Shirley Soule inspected Friendship Group Home on February 28, 2001. Both are experienced members of an oversight group appointed by the Governor of the State of Florida which advocates for the developmentally disabled. Their unannounced inspection was in response to abuse reports received by Respondent. They characterized the facility as "filthy and foul smelling"; "the buildings were in disrepair and in need of paint"; an in-ground swimming pool on the premises was filled with "green water"; a "horrible odor" was emanating from the back yard (Mr. Oliver advised them that the odor was from the septic tank which had been damaged and was open); soiled clothing, bed linen and mattresses were found throughout the living areas; and medications were found in an unlocked cabinet and not organized by client. Mss. Smith and Soule made additional observations which were consistent with the observations of Mr. Anderson, the health department inspector. Each of these witnesses had the opportunity and capacity to objectively observe the condition of Friendship Group Home and its clients. The observations and concern for the conditions as expressed by Mss. Smith and Soule are credible and accepted by the undersigned. Respondent was contacted by both Mr. Anderson and Mss. Smith and Soule and advised of the conditions found at Friendship Group Home. In response to the complaint from the local advocacy council members, Respondent conducted an inspection of the facility on March 22, 2001. The March 22, 2001, inspection confirmed the observations of Mr. Anderson, Ms. Smith and Ms. Soule. In particular, the inspection noted the following: linen upon the beds was heavily soiled with dirt and body oils that appeared to have been there for some time; some beds had blankets on them and the blankets were in the same condition; and mattresses were torn and ripped. Linen was piled the in the laundry area which is outside of a building; the linen had been there so long, that weeds were growing through the linen pile. Client records were not being kept in accordance with Florida Administrative Code rules. While Mr. Oliver produced a folder containing loose papers for some of the clients, he was unable to produce records on each client that provided a record of expenditures and required medical information. Medications were maintained in an unlocked cabinet which included the medications of clients who were no longer living in the facility. Staff background screening information and records of in-service training were not available. Food supplies were not available in appropriate quantities. Toilets were unclean and badly stained; bathroom floors were wet, water damage was present; and furniture was dirty, and broken down. The entire premises smelled of urine. Air-conditioners were not working, and living quarters were poorly ventilated. Dead roaches were in cabinets. The pool was green, and the bottom could not be seen because of the algae. In a March 28, 2001, letter, Respondent specifically advised John Oliver of the "deficiencies and repairs." The letter also advised "[A]fter completion of required work and the Fire/Health department's re-inspection, an additional site visit will be conducted prior to a new application for renewal is approved." On April 24, 2001, Otis Clay Oliver applied for license renewal for a developmental services residential facility for a maximum client capacity of 14. On May 4, 2001, a survey/inspection of the facility was conducted in response to the application for license renewal. Although improvement from the March 22, 2001, inspection was noted, there were still missing and incomplete client records, records of individual expenditures were not being kept, staff records of training and Florida Department of Law Enforcement background checks were not in place, no written plan of emergency procedures was on file, no intake and placement plan was available, air-conditioners were still inoperable, the facility was still in disrepair, linens and beds still needed to be replaced, a menu reviewed annually by a dietician was not available, and other violations were present. A May 29, 2001, letter to Mr. John Oliver advised that a three-month "conditional" license had been approved with an issue date of June 1, 2001. Although advised of the right to hearing if there was disagreement with the conditional license, no hearing was requested. The May 29, 2001, letter, which enclosed the May 4, 2001, survey findings, further advised: "Follow-up to sections A.2 (Budget and Finance), A.3.1.1 (Clients records), A.4 (Personnel) A.5 (Staff Training) A.6 (Client Rights) A.7 (Emergency Procedures) A.8 (Intake and Placement) H.2.9 (fire and safety) and H.3. (Facility Plant) H.4 (Maintenance and Storage) H.5 (Food Service) is required. Please forward notification as soon as possible-but no later than close of business Friday, June 29, 2001-that these requirement [sic] has been met." The May 4, 2001, survey is formally titled, "Statement of Survey Findings/Deficiencies/Plan of Correction." The survey, as its title indicates, lists "Findings/Deficiencies," (violations of Florida Administrative Code rules), and for each finding/deficiency there is a listed "Plan of Corrective Action," and a "Completion Date." The completion date indicated for each activity was June 30, 2001. June 30, 2001, was a Saturday. To avoid confusion, on June 6, 2001, Respondent sent John Oliver a letter reiterating the completion date of Friday, June 29, 2001, as indicated in the May 29, 2001, letter. On June 28, 2001, John Oliver forwarded a "Response to Statement of Survey Findings/Deficiencies/Plan of Action." He understood that the violations of the Florida Administrative Code rules as noted in the May 14, 2001 [sic], "Statement of Survey Findings/Deficiencies/Plan of Correction," were to be completed by June 29, 2001. On July 2, 2001, Respondent re-inspected Friendship Group Home and found the following: Records of expenditures from individual resident accounts are not being appropriately kept (violation of Rule 65B-6.010(2)(b), Florida Administrative Code). Individual records were missing medical summaries, records of clients' illnesses while resident in the facility, and written authorization for routine medical and dental care for clients were not present (violation of Rule 65B- 6.010(3)(a)(2) and (4), Florida Administrative Code). Personnel files lack written references, job descriptions, records of in- service training and affidavits of good moral character (violation of Rule 65B-6.010(5), Florida Administrative Code). There was no written emergency plan (violation of Rule 65B- 6.009(23)(b), Florida Administrative Code). One client's room needed an air-conditioner or other adequate cooling mechanism; the same room required ceiling repairs (violation of Rule 65B- 6.010(8)(i)and(l), Florida Administrative Code). Bed linens were not replaced with clean linen at least once a week (violation of Rule 65B-6.010(8)(c)(8), Florida Administrative Code). Meals were neither supervised by a nutritionists [sic], nor conducted pursuant to annual consultation with a dietitian (violation of Rule 65B-6.010(9)(c)(1), Florida Administrative Code). On July 13, 2001, Respondent notified Petitioners by letter titled, "Notice of Revocation of License" that their conditional license had been revoked. It advised, "[Y]our plan of action dated June 28, 2001, and indeed the present condition of your facility and its records, do not meet the requirements of your conditional license. In particular (but not inclusive of all noted violations), you have failed to properly address section H.3 (Facility Plant) of the May 14, 2001 [sic], survey. The conditions of the facilities [sic] roof, bathroom areas, bedding and swimming pool remain substandard." This letter then referenced the July 2, 2001, "home visit," delineating additional specific violations (paragraph 21, supra). The observations and reports of the inspections of March 22, May 4, and July 2, 2001, by Laura Lucas are accepted as credible. Although suggested by Petitioners, Ms. Lucas did not demonstrate bias, interest or ulterior motive. Her observations were consistent with other witnesses and, to some degree, confirmed by Petitioner, John Oliver. As evidenced by the July 2, 2001, inspection by Respondent, Petitioners failed to complete the Plan of Correction delineated in the May 14, 2001 (incorrectly date- referencing the May 4, 2001 survey), "Statement of Survey Findings/Deficiencies/Plan of Correction."
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that a final order be entered affirming the revocation of the conditional license of Otis C. Oliver and John R. Oliver issued on June 1, 2001, to operate a group home residential facility. DONE AND ENTERED this 25th day of July, 2002, in Tallahassee, Leon County, Florida. JEFF B. CLARK 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 25th day of July, 2002.
Findings Of Fact General Background At all times material hereto, Carol's Care Center (CCC) was a licensed nursing home facility certified to and participating in the Florida Medicaid Program. (Stip.) At all times material hereto, Volusia County owned the facility, which was an indigent nursing home. The first wing of the facility was constructed in 1954, at a time when there were no building codes for Volusia County. Volusia County operated the nursing home until 1968, at which time the county leased the nursing home to Dr. George Erickson. Both Volusia County and Dr. Erickson suffered financial losses in the operation of the nursing home. (Tr. 43, 162) In 1969, Carol E. Forrer and her son, Walter Littler, took over operation of the nursing home. Under their contract with Volusia County, the nursing home was required to accept up to 95 percent indigent patients. Another clause in that contract required the remaining five percent of the nursing home's beds to be available for Medicaid patients, if needed. Almost all of the nursing home patients were indigent. (Tr. 44, 162, 163) CCC experienced serious and continuous financial problems prior to 1979 because of the number of indigent or Medicaid patients placed at CCC. Funds were always short. In addition, the building was antiquated and in such poor condition that it required at least six staff people on the payroll to do only maintenance work. The reputation of the facility was horrendous. In addition, staff was difficult to find and keep because of low pay and poor working conditions. In fact, turnover was 105 percent. In 1979, Mrs. Forrer had extreme difficulty in getting physicians and nurses to treat patients in the nursing home. In early 1979, the Department of Health and Rehabilitative Services (Department) informed Mrs. Forrer that the building was not in conformance with licensure standards and would not be allowed to continue operation as a nursing home. Mrs. Forrer knew that a new facility had to be built, but she could not finance the necessary expenses because the county owned the facility. (Tr. 45, 48, 162, 165) In an effort to solve many of the problems at the nursing home, Mrs. Forrer hired Progressive Management Group (PMG) in July of 1979 to operate and administer the facility. Mrs. Forrer stayed on as administrator for August, 1979, during the transition period in which PMG took over. The Department disallowed $2,109 of her salary on the basis that there could not be two administrators. (Tr. 45, 46) On December 31, 1979, CCC had 134 beds, and its occupancy rate was approximately 97 percent. Of the patients at CCC, 88 to 92 percent were Medicaid patients. When Charles F. Cantrell, Jr., purchased all of Mrs. Forrer's stock in the 344 Corporation and assumed responsibility for the operation of CCC, the nursing home had the highest Medicaid percentage in the area because local doctors were not referring private patients to the nursing home. Private patients generate revenues that can be used to offset expenses for Medicaid patients. (Tr. 50, 51, 52) On December 31, 1979, Mr. Cantrell purchased Mrs. Forrer's stock and assumed any liabilities arising from the audits of CCC by the Department for the fiscal years 1978 and 1979. (Tr. 45, 70) The Department conducted audits of CCC for the fiscal years ending August 31, 1978, 1979 and 1980. The audits for fiscal years 1978 and 1979 were conducted by Hugo Jordan, an auditor employed by the Department. The Medicaid Program is a joint federal and state program. It is governed by the Florida Title XIX Medicaid Reimbursement Plan and the applicable doctrines in HIM-15. The Medicaid cost reports for CCC in fiscal years 1978, 1979 and 1980 were timely filed. This dispute arose from audit adjustments to CCC's Medicaid cost reports for fiscal years 1978, 1979 and 1980. (Stip.; Tr. 289; Petitioner's Exhibits 4, 5, 6) Activities of Charles F. Cantrell, Jr. The Department notified CCC that it would not be relicensed in the absence of major alterations of the physical plant to bring it up to existing standards. This was impossible because of the state of the existing building. Cantrell negotiated an arrangement with the Department that CCC would continue to be licensed upon the condition that major intermediate repairs be made to the existing facility and a new facility be built within 30 months. (Tr. 49, 57, 151) Cantrell was obliged to continue to operate CCC in the existing facility, making the necessary repairs to the physical plant, upgrading staffing and establishing an effective bookkeeping system while also undertaking to plan, finance and build a new facility. All of these actions were necessary to meet conditions for Department licensure and to continue operating the facility which was the primary facility in the area providing care for indigent and Medicaid patients. (Tr. 49, 57, 59, 151) Cantrell took a direct hand in the management and operation of the facility. He assumed the business management of CCC, supervising and arranging for maintenance and repairs, revamping the bookkeeping system and training personnel, and coordinating activities related to the planning, financing, certification and building of the new facility. All of his activities were necessary. Cantrell's prior experience as the owner of several businesses, including a small chain of drug stores, and his experience in providing professional services to nursing homes assisted him in keeping CCC operating and in establishing the new facility which is now in operation. Cantrell was a salaried management employee of CCC for eight months in fiscal year 1980. He was paid $37,977 by CCC for his services. Under Department guidelines, the annual salary for the administrator of a facility the size of CCC was $27,032. Cantrell dismissed PMG shortly after he took control on December 31, 1979. Because he was not a licensed administrator, Cantrell employed Mrs. Forrer for several weeks as an interim administrator. Cantrell hired Buford Jones as the permanent administrator in March, 1980. Jones is still in this position. Jones and Mrs. Forrer were assigned duties related to patient care, staffing and record-keeping related to patient care. The Department audit disallowed one month of Cantrell's compensation in total because his service overlapped that of two other administrators. In addition, the Department reduced Cantrell's salary to that of an assistant administrator/owner. The total disallowed by the Department was $25,277. The Department disallowed $1,195 of Mrs. Forrer's salary for the fiscal year ending August 31, 1980, on the same grounds. The field auditor for the Department disallowed a portion of Mrs. Forrer's salary in fiscal year 1979, when PMG was employed, because of overlapping administrators. The Department's auditor took the position that there could not be two administrators at the same time. The total salary paid Mrs. Forrer for the periods of transition in August of 1979 and January, 1980, when her employment overlapped that of another administrator, were legitimate. Both administrators were head administrators, one leaving and one coming. The maintenance of continuity and the benefits flowing to the patients warrant such a transition. The auditor for CCC, Betty Kelly, C.P.A., gave her expert opinion, based upon her personal observation of Cantrell's activities and the duties he performed. Cantrell's activities were necessary, and, had he not performed them, someone would have had to be hired to do those jobs. The salary he received was reasonable and consistent with salaries paid other persons for similar work. The situation at CCC was unusual, and its many problems justified additional management, expertise and personnel. CCC needed more than an assistant manager. It needed a separate manager to handle business operations until its inherent problems could be solved. Cantrell provided this expertise. Drug Expenses In fiscal year 1978, the Department disallowed $1,894 in prescription drug expenses on the grounds that prescription drugs are not covered under the Florida Medicaid Program. (Petitioner's Exhibit 4) In 1978, the Florida Medicaid drug program permitted patients to purchase $33 worth of legend drugs with a monthly Medicaid eligibility card. Some patients exceeded the limits on their card and had to apply for an excess prescribed medicine grant. In order to apply for the grant, the patient forwarded a form to the attending physician. (Tr. 84, 85, 86) The drug information portion of the form was to be completed by the physician and submitted to Jacksonville or to Tallahassee, where a board of physicians would review the request. The physicians, in general, were unable or unwilling to fill out these forms because they could not obtain the needed information. As a pharmacist, Cantrell applied for 700 to 800 excess prescribed medicine grants, but only ten were approved for increases. (Tr. 86, 87) Since some drugs are life-sustaining, CCC assumed the responsibility in fiscal year 1978 of paying the pharmacist for the excess cost of a Medicaid patient's prescription drugs. The amount of $1,894 represents the excess of purchases of drugs from The Medicine Shoppe. (Petitioner's Exhibit 16) Nursing homes are responsible for supplying their patients with prescribed drugs. Rental Equipment In fiscal year 1978, the Department disallowed $2,444, which represented 100 percent of the costs of a leased automobile. In fiscal year 1979, the Department disallowed $2,270, which represented 100 percent of the costs of a leased automobile. (Petitioner's Exhibits 4, 5) CCC operated three vehicles in 1978: a maintenance vehicle, a Pontiac Grand Prix, and a Dodge van. The maintenance vehicle was used to haul lumber and other items. The van contained a lift and was designed to transport patients. The van was used to transport patients until its insurance was raised to $3,600 per six months because of installation of the lift. It was thereafter not used to transport patients. The Pontiac was rented for that purpose, with insurance being included in the rental charges. Eventually, the maintenance vehicle was disposed of and the van used by maintenance personnel. (Tr. 169, 170, 176) All three vehicles were kept at the facility, and they were all used for patient-related activities. The Pontiac was used to transport patients. Mr. Littler also used it to conduct nursing home business in Tallahassee and Jacksonville. Littler left his personal car at the facility whenever he took the Pontiac and did not charge the costs of this vehicle to the Medicaid program. (Tr. 72, 172) Depreciation of Camper The Department disallowed $295 in fiscal year 1978 for depreciation on a camper as not related to patient care. (Petitioner's Exhibit 4) The camper in question was used by Dr. Legg, a scientist, while he was conducting studies related to the certificate of need for the new facility. (Tr. 178, 179) Advertising and Promotion In fiscal year 1978, the Department disallowed $210 on the grounds that it constituted promotional advertising. (Petitioner's Exhibit 4) The amount contained in Petitioner's proposed recommended order exceeded the amount disallowed. None of the advertising was for the purpose of hiring staff. The aerial photograph was taken for use in settling a property dispute with the city. It was directly related to cost containment in operating the facility by reducing maintenance requirements and taxes. As such, this provided a benefit to the patients and to the public. Utility Expense In fiscal year 1978, the Department disallowed $272, claiming that this was for utility bills for a commercial building owned by Mr. Littler. (Tr. 196; Petitioner's Exhibit 4) At said time, the Department cited CCC for not having proper beds. Littler used the building to refurbish beds for the facility according to the Department's standards. More than 100 beds were refurbished on the property owned by Littler. The only demand Littler made in return for the use of his building was that CCC pay his utility bills during the period of time that the beds were being refurbished. (Tr. 197) These utility bills paid by CCC were in actuality the rental assessed for use of the building. Considering the period of use, the rental was reasonable. Additional Rents The Department disallowed $2,000 in fiscal year 1978 for rent paid to Volusia County. (Tr. 198; Petitioner's Exhibit 4) The records of CCC reflect that it paid $38,000 in rents to Volusia County in 1978. The contractual rental was $36,000 per year. The auditor concluded, based upon data which he believed was given him by a bookkeeper, that the $2,000 was a late payment of 1977 rents. The uncontroverted testimony of Mr. Littler was to the contrary. Volusia County was to pay for repairs to the facility under the terms of the lease, but it did not have the money to pay for repairs required by the Department. It was agreed that CCC would pay Volusia County $2,000 for a sinking fund to cover future repairs. The $2,000 paid to this fund was not used to pay for repairs and was not for rental. The county retained it. Gasoline Expense In fiscal year 1980, the Department disallowed $380 of gasoline expense which was used in the vehicles of CCC's employees when they used their vehicles for patient-related activities. Petitioner is not challenging $133 of this adjustment. (Petitioner's Exhibits 6, 18) CCC has one gasoline credit card that is kept by Mr. Jones to supply fuel to vehicles that are used in the service of the nursing home. (Tr. 108) Jones only allowed other employees to use the gasoline credit card for patient-related activities. Cantrell never used the gasoline credit card for his own vehicle because he has another card. Employees who have used the gasoline credit card are the administrator, the activities director, the maintenance-man and the secretary. (Tr. 108, 109, 239) The amount of $247 would be an expense related to operations of the facility. Professional Services In fiscal year 1980, the Department disallowed $1,061 as costs incurred in the prior year. (Petitioner's Exhibit 6) The legitimacy of the expense is not at issue, and it was disallowed solely because it was not incurred in fiscal year 1980. These expenses were inadvertently omitted from the 1979 cost report. (Tr. 272; Petitioner's Exhibits 18, 19) The expenses for the 1979 audit are also at issue in these proceedings. Travel and Expense The Department disallowed $821 in fiscal year 1978 because the expense was considered personal. Petitioner does not challenge $247 of this adjustment. (Petitioner's Exhibit 4) A portion of this expense is related to the expenses incurred by Mr. Littler to go to Washington, D.C., to participate in what was primarily a lobbying effort. This was not for the benefit of the patients or to increase the professional skills of Littler. Each administrator who is licensed by the State of Florida must attend a certain number of seminars every year as a condition of licensure. Mrs. Forrer and Littler registered and participated in the Miami seminar to expand their knowledge and to maintain their nursing home administrators' licenses. Mr. Jordan admitted that he erred in disallowing $157 for Mrs. Forrer's hotel room on this trip. Littler's room expense for this trip was $170. No travel expense was validated. (Tr. 188, 189, 291) Littler attended a seminar in Atlanta on cost reporting sponsored by the University of Pennsylvania. His American Express invoices contain a record of certain expenses which he incurred while attending this seminar. This was an activity related to Littler's professional qualification and to the business operations of CCC. The travel and room expense were $206. (Tr. 191; Petitioner's Exhibit 14) Mrs. Forrer's and Littler's expenses for the trips to Miami and Atlanta are $533. Other exhibits include expenses not mentioned in Petitioner's proposed recommended order. It is assumed that the Petitioner has abandoned those claims, and no findings are made regarding them. Travel and Expense In fiscal year 1979, the Department disallowed $113 as an expense that was not actually spent in that year. Petitioner asserts that the $113 was refunded in 1980, and the 1980 expenses reduced by that amount. This is based upon the testimony of the facility's accountant at pages 275 and 276. The effect of the accounting treatment was to reduce the 1980 expenses by $113. The result is that the Department deducted the $113 in 1979, and the accountant deducted the $113 again in 1980.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, the following is recommended: The adjustment to Cantrell's salary should be reduced from $25,277 to $19,956; The adjustment to Mrs. Forrer's salary of $1,915 in 1979, and of $2,109 in 1980, should be rescinded; The adjustment for drug expenses of $1,894 should not be altered; The adjustment of $4,714 for rental of a Pontiac Grand Prix in 1978 and 1979 should be rescinded; The adjustment of $295 for depreciation of the camper should not be altered; The adjustment of $210 for advertisements should be reduced by $125, the cost of the aerial photograph; The adjustment of $272 for utility expense should be rescinded; The adjustment of $2,000 for rentals should not be altered; The adjustment of $380 for gasoline expense should be reduced by $247; The adjustment of $1,061 for professional services should be rescinded unless other grounds exist to deny an amendment of the previous year's report; The adjustment of $821 for travel and expense should be reduced by $533; and The adjustment of $113 for travel in 1979 should be rescinded unless other grounds exist to deny an amendment of the previous year's report. DONE and RECOMMENDED this 16th day of February, 1983, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, 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 16th day of February, 1983. COPIES FURNISHED: Karen L. Goldsmith, Esquire Michael J. Bittman, Esquire Day Building, Suite 610 605 East Robinson Street Post Office Box 1980 Orlando, Florida 32802 Joseph L. Shields, Esquire Office of Audit and Quality Control Services Department of HRS 1323 Winewood Boulevard Tallahassee, Florida 32301 David H. Pingree, Secretary Department of HRS 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact The Petitioner timely applied on November 30, 1984 for home energy assistance under the Low-Income Home Energy Assistance Program as authorized by Title XXVI of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35). Petitioners' only income was "unearned income" which was their monthly social security benefit payments which totalled $561.00. No monthly medicare premiums were deducted from Petitioners' monthly social security payments. The Respondent in calculating Petitioners' verified monthly income added a total of $29.20 back into Petitioners' total monthly income of $561.00 for an adjusted total verified monthly income of $590.20. On April 10, 1985 Respondent officially notified Petitioners that the monthly income of $590.20 exceeded the monthly income limit ($560.00) for their household. Respondent upon discovering that medicare premiums were not deducted from Petitioners' monthly social security payments readjusted Petitioners' total verified household income to $561.00. Petitioners agree that their verified monthly income during the month of application was $561.00. The monthly income limit for a household the size of Petitioners' as determined under Rule lOC-29.13, Florida Administrative Code is $560.00. Petitioners had no excludable income. Other than exceeding the monthly income limit of $560.00 for household the size of Petitioners', the Petitioners were eligible for assistance under the Low-Income Home Energy Assistance Program.
Recommendation Based upon the findings of facts and conclusions of law recited herein, it is RECOMMENDED that the Respondent enter Final Order denying the Petitioners' application for assistance under the Low-Income Home Energy Assistance Program. Respectfully submitted and entered this 19th of August, 1985, in Tallahassee, Leon County, Florida. WILLIAM R. CAVE 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 August, 1985. COPIES FURNISHED: Harold Braynon, Esq. HRS District Ten Legal Counsel 201 West Broward Boulevard Fort Lauderdale, FL 33301-1885 Charles V. and Helen Tokarski 6804 N.W. 29th Street, Lot 1, Block 32 Margate, FL 33063 Susan Kirkland, Esq. Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, FL 32301 David Pingree Secretary 1323 Winewood Boulevard Tallahassee, FL 32301 ================================================================ =
Findings Of Fact Suburban Nursing and Mobile Homes, Inc., of Ohio, at all material times, wholly owned the stock of G & J, an owner of land, buildings and equipment of two nursing homes, Krestview Nursing Home and Towne House Convalescent Center located in Miami, Florida. Suburban was a holding company which owned the stock of numerous subsidiary corporations engaged in the nursing home or mobile home park business. Among its subsidiaries was B & K Investments, Inc. (hereafter "B & K") a Florida corporation. All of the stock of Suburban was controlled by Gerald D. Keller. On May 5, 1977, at the request of the Department, B & K became the licensed provider for Krestview and Towne House and G & J became the landlord. Both landlord and tenant were wholly owned by the same parent corporation. Since Medicaid rules and regulations prohibited the payment of rent by a provider to a related-party landlord, Keller arranged in May of 1977, for the sale of the stock of B & K to unrelated parties in an arm's-length transaction. Petitioner's assignor, B & K, entered into written provider agreements with the Department for the operation of the two nursing homes. That provider agreement states, in pertinent part, that: In instances of non-payment or underpayment conditions due to error(s) not attributable to provider who has furnished nursing home services and care to persons properly certified and eligible, the single state agency (HRS) shall make payment to the provider upon receipt of properly completed claims documents. (Petitioner's Exhibit 13, 13a.) (Emphasis added.) During 1978 and 1979, the Department set reimbursement rates for B & K inconsistently. During this period of time, B & K experienced at least eight different retroactive increases or decreases in a period of less than twelve months. Additionally, the relationship between the parties was increasingly strained during 1978, as evidenced by Petitioners Exhibit 18, in which a medicaid audit evaluation and review analyst, in considering cost factors at Krestview, speculated that the "Ohio group would get out of the business in Florida." In August, 1979, the independently owned B & K d/b/a Krestview Nursing Home and Towne House Convalescent Center, filed a petition in bankruptcy. Among its creditors were G & J, the landlord, which filed a secured claim in excess of $300,000 for unpaid rents. At that time B & K had not yet filed cost reports for its fiscal year ending May 31, 1979, and had filed no cost reports for the period May 31 through August 31, 1979. The trustee made a determination to file those cost reports on behalf of the bankrupt if the cost reports could be prepared. The trustee requested B & K's former accountant to prepare the cost reports. When it became apparent that the accountant was unwilling to prepare the reports without a substantial advance payment and that no funds were available to pay for such services, the trustee looked elsewhere. Keller's holding company, Suburban, owned the stock of Nursing Home Consultants, Inc., an Ohio corporation engaged in the business of providing accounting services to health care organizations. Keller had an obvious interest in offering the services of his corporation on a contingent basis since he had a $300,000 secured claim against the bankrupt whose only visible asset was the monies it asserted were due from the Department as a result of reimbursable expenses. The proposal advanced by Keller was accepted by the trustee in bankruptcy, Jennette E. Tavormina, and Judge, Thomas C. Brutton, bankruptcy judge. The court entered an order appointing Nursing Home Consultants to prepare the cost reports. Nursing Home Consultants attempted to obtain the accountant's work papers to begin preparing the cost reports, however, it was not until December, 1980, when faced with possible action from the court, that the accountant made his papers available and the time-consuming tasks of matching checks to invoices, verifying patient records and documenting expenses began. In July of 1981, Nursing Home Consultants completed the first of the cost reports and forwarded it to the trustee. The trustee in turn filed the cost report with the Department. It was returned to Nursing Home Consultants because the person who had certified the reports was not a certified public accountant in Ohio. Nursing Home Consultants had the returned cost report recertified by an independent firm of certified public accountants in Ohio. Considerable time elapsed and as of July, 1982, the cost reports for the second facility had not been completed. Both the trustee and the bankruptcy judge desired to close the estate and ascertain what, if any, assets were present. G & J made a written offer to the trustee to purchase the trustee's right, title and interest and claims, if any, in and to the Medicare/Medicaid cost reports of the bankrupt. In consideration, G & J offered the sum of $5,000 together with the waiver of its claim for rents due and owing from B & K and any and all claims against the estate for the costs and expenses incurred in the preparation of the cost reports. A hearing was held on September 23, 1982, after notice to all creditors, concerning whether G & J's offer should be accepted. The Department appeared at the hearing and opposed the sale. The offer was accepted by the trustee and ratified and approved by the court on September 24, 1982. The objection entered by the Department to the sale was specifically denied. No appeal of the court's order was taken by the Department. On February 7, 1983, G & J, as assignee, under the bankruptcy court's order, filed the cost reports with the Department for review and audit. The Department returned the cost reports outlining its reasons by letter dated March 25, 1983, and set forth above. The cost reports for the period May 5, 1977 through May 31, 1978, were initially submitted by B & K and accepted by the Department on November 1, 1978. The final audit of those reports was not completed until December 26, 1979, for Krestview, and February 15, 1980, for Towne House, after B & K had filed for bankruptcy. While the audit was being conducted, B & K was granted extensions of time for the filing of the 1978-1979 cost reports. After the trustee in bankruptcy was appointed and began the process of attempting to prepare the cost reports, the Department conducted a final audit of the 1977-1978 cost reports. The Department failed to provide either B & K or the trustee with a copy of any proposed audit adjustments. No evidence was presented that B & K or the trustee was given an exit conference where the audit findings were discussed and explained. Instead, the Department distributed the final audit but failed at that time to advise B & K, the trustee or the Bankruptcy Court of any right to challenge the audit pursuant to Section 120.57, Florida Statutes.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED: That the Department enter a Final Order accepting for audit the cost reports submitted by the Petitioner G & J Investments Corporation, Inc., for B & K Investments, Inc., for the periods May, 1977 through August 1979. DONE and ENTERED this 6th day of February, 1984, 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 6 day of February, 1984. COPIES FURNISHED: Patricia A. Peoples, Esquire R. Stuart Huff, Esquire 330 Alhambra Circle Coral Gables, Florida 33134 Joseph L. Shields, Esquire Department of Health and Rehabilitative Services 1317 Winewood Boulevard Tallahassee, Florida 32301 David H. Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301 Alicia Jacobs, Esquire General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
The Issue The issue is whether Respondent is entitled to the renewal of his license to operate an adult family-care home.
Findings Of Fact At all material times, Petitioner has operated an adult family-care home at 7128 North 50th Street in Tampa. Petitioner owns this home with his cousin. In anticipation of the expiration of his license on September 29, 2006, Petitioner filed with Respondent an application for renewal on May 23, 2006. Renewal applications prompt annual survey inspections, so, after the receipt of Petitioner's renewal application, one of Respondent's surveyors visited the home and performed an annual survey inspection. She noted items that required a follow-up inspection, so, on August 3, 2006, one of Respondent's surveyors returned for the follow-up inspection. Respondent's surveyor was met at the door by Sherille Guider, who stated that she was the caregiver. The surveyor asked to see Petitioner, but she told her that Petitioner did not live at the house, although she showed the surveyor the locked room that belonged to Petitioner. When asked to produce certain routine documents, the caregiver replied that she did not have access to such documents, as they were in the locked room of Petitioner and the caregiver did not have a key. Petitioner appeared a short time after the surveyor's arrival and produced the requested documents. There is some dispute as to whether he offered to show his room to the inspector, but his testimony is unrebutted that he kept a room, with clothes and toiletries, for his exclusive use at the home. He claimed that he resided at the home, although he admitted that did not spend every night there. Subsequent investigation revealed that Petitioner and his wife, from whom he has been separated for two years, claim a different residence within Hillsborough County as their homestead property. Also, Petitioner's driver license currently bears the address of the home, but, at the time of the incident, bore the address of his homestead property. The same appears to be true of the certificate of title to his motor vehicle. Petitioner testified that he originally planned to operate the home as his fulltime job, but was unable to generate enough money doing so. He has since found employment as a certified nursing assistant and often works the 11:00 p.m. to 7:00 a.m. shift. Four or five months prior to the follow-up inspection, Petitioner had hired Ms. Guider to serve as a caregiver at the home. In return for her services as a caregiver, Petitioner rented a room in the home to her at reduced rent. Petitioner allowed her boyfriend also to move into a room, but required a background screening on him, as well as on Ms. Guider. After several delays, the boyfriend completed his form, and, after submitting it, Petitioner learned that the boyfriend had a criminal record. Petitioner demanded that the boyfriend move out. Eventually, Petitioner had to summon law enforcement officers to eject the man. This episode preceded the follow-up inspection. Ms. Guider's hearsay statement to Respondent's surveyor appears to be the strongest evidence on which Respondent is relying in this case. However, for the reason noted above, Ms. Guider was unhappy with Petitioner. Even before her boyfriend had been ejected from the home, Ms. Guider had approached Petitioner's two residents with a plan for her to start her own adult family-care home and for them to move into it. Ms. Guider's short period of employment with Petitioner terminated one day when, without notice, she asked a friend of Petitioner to drive her to the airport so she could fly home to Chicago. She did and never returned. For all these reasons, Ms. Guider does not appear to be a reliable source of information as to Petitioner's place of residence. Petitioner testified that he resides at the home. A friend of 20 years, who also operates an adult family-care home, testified that she visits Petitioner's home regularly and knows that he resides there. Petitioner's claiming of homestead exemption at another address is less evidence of his primary residence and more evidence of his carelessness or fraud in maintaining current information with the Hillsborough County property appraiser's office. The old addresses shown on the driver license and certificate of title are of little importance in determining Petitioner's residence, given the other evidence establishing the home as his residence and his subsequent updating of the addresses in these official records.
Recommendation It is RECOMMENDED that the Agency for Health Care Administration enter a final order granting Petitioner's application to renew his adult family-care home license. DONE AND ENTERED this 16th day of April, 2007, in Tallahassee, Leon County, Florida. S ROBERT E. MEALE 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 16th day of April, 2007. COPIES FURNISHED: Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Craig H. Smith, General Counsel Agency for Health Care Administration Fort Knox Building, Suite 3431 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Dr. Andrew C. Agwunobi, Secretary Agency for Health Care Administration Fort Knox Building, Suite 3116 2727 Mahan Drive Tallahassee, Florida 32308 Kenneth A. Donaldson 7128 North 50th Street Tampa, Florida 33617 Gerald L. Pickett Agency for Health Care Administration 525 Mirror Lake Drive Sebring Building, 330K St. Petersburg, Florida 33701
