Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the L x. of , 2014, in Tallahassee, Florida. Be At yf. yor’ ABETH DUIEK, SECRETARY Agency for Health Care Administration 1 AHCA vs. Roberto Uriel, M.D., South Florida Pediatrics, C.}. 13-0344-000 Final Order Filed May 8, 2014 1:44 PM Division of Administrative Hearings A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Beverly H. Smith Assistant General Counsel Agency for Health Care Administration Office of the General Counsel (Interoffice Mail) Christopher A. Parrella, J.D., CHC, CPC, CPCO The Health Law Offices of Anthony C. Vitale, P.A. Law Center of Brickell Bay 2333 Brickell Avenue, Suite A-1 Miami, FL 33129 (U.S. Mail) Richard Zenuch, Chief, Medicaid Program Integrity Finance and Accounting Health Quality Assurance Florida Department of Health 2 AHCA vs. Roberto Uriel, M.D., South Florida Pediatrics, C.I. 13-0344-000 Final Order CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail or other designated method on this the Bas of 45 , 2014, Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308-5403 (850) 412-3630/FAX (850) 921-0158 3 AHCA vs. Roberto Uriel, M.D., South Florida Pediatrics, C.1. 13-0344-000 Final Order
The Issue Whether the Division of Administrative Hearings (DOAH) has jurisdiction to conduct a formal hearing under the provisions of Sections 120.569 and 120.57(1), Florida Statutes, if the Florida Commission on Human Relations (FCHR) does not make a "cause" or "no cause" determination, as provided in Section 760.11(3), Florida Statutes, but rather issues a Notice of Dismissal, pursuant to Section 760.11(8), Florida Statutes. Whether DOAH has jurisdiction to conduct a formal hearing under the provisions of Sections 120.569 and 120.57(1), Florida Statutes, if the Petition for Relief was not timely filed pursuant to Section 760.11(6), Florida Statutes. Whether DOAH has jurisdiction to conduct a formal hearing under the provisions of Sections 120.569 and 120.57(1), Florida Statutes, if Petitioner fails to name Respondent in the Petition for Relief filed with the FCHR, as required by Section 760.11(1), Florida Statutes.
Recommendation Based on the foregoing facts and conclusions of law, it is RECOMMENDED that a final order be entered dismissing with prejudice the Petition of Manuel Pedraza in DOAH Case No. 02-0237, and FCHR Case No. 99-0849, for failure to timely file his Petition for Relief and for failure to properly name Respondent in the Petition. DONE AND ENTERED this 21st day of June, 2002, in Tallahassee, Leon County, Florida. ___________________________________ DANIEL M. KILBRIDE 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 21st day of June, 2002. COPIES FURNISHED: Susan K. W. Erlenbach, Esquire Erlenbach Law Offices, P.A. 2532 Garden Street Titusville, Florida 32796 W. Russell Hamilton, III, Esquire Morgan, Lewis & Bockius, LLP 5300 First Union Financial Center 200 South Biscayne Boulevard Miami, Florida 33131-2339 Denise Crawford, Agency Clerk Florida Commission on Human Relations 2009 Apalachee Parkway, Suite 100 Tallahassee, Florida 32301 Cecil Howard, General Counsel Florida Commission on Human Relations 2009 Apalachee Parkway, Suite 100 Tallahassee, Florida 32301
The Issue The issues are (a) whether petitioners' budget letters for fiscal year 1991-1992 should be accepted by respondent, and (b) whether the agency has utilized a non-rule policy in rejecting the letters, and if so, whether the policy has been adequately explained and justified.
Findings Of Fact Based upon all of the evidence, the following findings of fact are determined: Background Petitioners are hospitals subject to the regulatory jurisdiction of respondent, Health Care Cost Containment Board (Board). As such, they are required to annually file their projected budgets with the Board for review and approval. This controversy relates to petitioners' fiscal year 1991-1992 budgets (1992 budget) and whether such filings conformed with the Board's requirements and should have been accepted. Budget letters for the fiscal year 1992 were filed by petitioners with the Board in May 1991. After the documents were reviewed by the Board's staff, on June 21, 1991, the Board issued virtually identical proposed agency action to each hospital advising the hospital that its budget letter was "nonconforming for the following reason: The hospital's maximum GRAA should be $ , instead of $ , ", with the appropriate dollar amounts inserted in the blanks. The letter went on to advise the hospital that it should resubmit a corrected budget document and until it did so, its submission would be considered incomplete. As provided for by agency rule, the hospitals then filed general and specific objections to this preliminary determination. After such objections were reviewed by the Board and presumably found to be without merit, petitioners requested a formal hearing to contest the proposed agency action. The Parties Petitioners are fourteen hospitals located throughout the State of Florida. Intervenor, Florida League of Hospitals, Inc., is a non-profit organization which is organized and maintained for the benefit of the proprietary hospitals which comprise its membership. The Board is a state agency charged with the responsibility of annually reviewing hospital budgets to insure that a hospital's charges do not exceed certain established thresholds. This is accomplished by an annual review of the budgets of all regulated hospitals. Intervenor, Citizens of the State of Florida, is represented by the Office of the Public Counsel. That office is charged with the responsibility of representing the citizens in all proceedings before the Board. The parties have stipulated that petitioners and the two intervenors have standing to initiate or participate in this proceeding. The Review Process As noted above, budgets must be filed on an annual basis at least ninety days prior to the beginning of a hospital's fiscal year. In these cases, all petitioners have fiscal years ending on August 31 and thus their budgets are due no later than June 1 of each year. There are two types of budget filings authorized by law. First, a hospital may file what is known as a budget letter, which is a one-page submission on a form provided by the Board. In the letter, the hospitals are required to acknowledge and certify to certain information contained in Subsection 407.50(2), Florida Statutes (1989). Secondly, a hospital may file a detailed budget which is more complicated than the budget letter and requires the completion of a twenty-seven page form. In a detailed filing, a hospital must provide, at a minimum, detailed information regarding the hospital's unit and hospital statistics, related party transactions, patient rates and discount policies, explanation of increases in revenue and expense, and prospective payment arrangements. The detailed budget filing is obviously a more expensive, complicated and time-consuming process than is the filing of a budget letter. It should be noted here that the current filing process was created by the legislature in 1988 when substantial amendments to the law were enacted. Those amendments provided, inter alia, that budget letters could be used for the first time beginning with fiscal year 1990. Prior to that time, all hospitals filed detailed budgets. Given the technical language which governs the Board's budget review process, a brief discussion regarding that process is appropriate. In very broad terms, the Board's principal function is to ensure that the revenues (charges) received by a hospital are not excessive or unreasonable. It performs this function by reviewing the budgets of each hospital during the annual budget review process. As is relevant to this controversy, the Board uses two major financial indicators in the review process. They are the gross revenues per adjusted admission and the maximum allowable rate of return, also known in regulatory parlance as the "GRAA" and "MARI", respectively. 1/ In order to measure the reasonableness of a hospital's charges, the Board requires each hospital to calculate a GRAA, which is the result of dividing the gross operating revenues of the hospital during a fiscal year by adjusted admissions. This financial indicator is basically a measure of revenue per case after adjusting for outpatient admissions and represents an average of all gross revenues per case. Except when authorized by the Board, a hospital may not increase its charges (GRAA) from one year to the next by more than its maximum allowable rate of increase. This percentage limitation, more commonly known as the MARI, is calculated pursuant to a statutorily defined formula. It is important to note that a budget letter is used when a hospital does not intend to increase its charges by more than the percentage amount specified in its approved MARI. Thus, in return for the hospital agreeing to operate within its MARI during the next fiscal year, the Board allows the hospital to have its budget approved through the less complicated budget letter process. Conversely, when a hospital intends to increase its charges from one fiscal year to the next by a greater percentage amount, it is obliged to file a detailed budget and subject itself to this more time-consuming process. In each budget letter filing, a "base GRAA" must be calculated. After that calculation is made, the base GRAA is then inflated by the hospital's MARI plus one, which produces what is known as the "budget letter GRAA". Thus, where a base GRAA is $10,000 and the MARI is 10%, the budget letter GRAA is $11,000, which is derived by multiplying the base GRAA ($10,000) by one plus the MARI (1 plus .10%, or 1.10). The budget letter GRAA represents the maximum projected gross revenues per adjusted admission the hospital can receive during the next fiscal year without having to justify the excess charges to the Board. The principal point of contention in these cases is the appropriate manner in which the base GRAA for each of petitioners' budget letters should be calculated. This in turn bears directly on the issue of whether petitioners are eligible to file a budget letter. There is no dispute as to the appropriate MARI, and the parties have agreed that the dollar figures and percentages applicable under each party's proposed calculations are accurately reflected in joint composite exhibit 1 received in evidence. Calculation of the Base GRAA Petitioners and supporting intervenor contend that the appropriate base GRAA should be calculated so as to most accurately reflect the GRAA from the previous fiscal year. In this vein, they have proposed three methodologies which are described on page 2 of joint composite exhibit 1 and are also discussed in greater detail in a subsequent portion of these findings. Petitioners cite the language in Subsection 407.50(2)(a), Florida Statutes (1989) as the authority for these approaches. On the other hand, the Board and its supporting intervenor assert that the GRAA base must be calculated by using the methodology identified as alternative 5 on page two of joint exhibit 1 and also described in Subsection 407.50(3), Florida Statutes (1989). In every case, this produced a smaller base GRAA than was proposed by petitioners, and unless they accede to the Board's calculation, they will be required to file detailed budgets. Like the petitioners, the Board and supporting intervenor also rely upon the language in Section 407.50, Florida Statutes (1989) as authority for their position. Even so, petitioners contend that respondent's methodology is actually a rule, not duly promulgated, and thus it must be justified and explained in this proceeding as is required of any non-rule policy. In a separate final order issued this same date in Case Nos. 91-4762R through 91- 4776R, the undersigned has determined that the methodology is in fact a policy having all of the attributes of a rule and thus it must be defended and explicated in a section 120.57(1) proceeding. Pursuant to a statutory amendment enacted in 1988, existing subsection 407.50(1) provided a so-called phase-in period for calculating a budget letter GRAA in fiscal years 1990 and 1991, and the manner for doing so was spelled out rather clearly in the law. The problem here lies in the fact that other provisions within section 407.50, which are not as clear as subsection 407.50(1), govern the filing of budget letters for fiscal year 1992 and beyond. The problem was recognized by the Board as early as July 1988 when its general counsel prepared a memorandum for Board members which compared the then existing law with amendments just adopted by the 1988 legislature. At that time, the Board was advised that for fiscal year 1992 and beyond, the base GRAA would be calculated in a manner generally consistent with the methodology proposed by the Board in these cases. This memorandum was placed in what is known as the "Board Book", a compilation of all documents considered by the Board at its meetings, and copies of the memorandum were later distributed to virtually all regulated hospitals in the State. The memorandum read in pertinent part as follows: For FY 1992 and beyond, will be determined as in following 1992 example. Base for 1992 budget will be 1990 actual GRAA unless 1990 actual GRAA exceeded 1989 actual GRAA by more than Board-approved MARI, 1991 base will be 1989 actual GRAA inflated by Board-approved rate of increase for 1990. In addition, at a technical advisory panel meeting held on November 7, 1990, hospital representatives were advised that while subsection 407.50(1) provided a phase-in period with a specified procedure for calculating a budget letter GRAA, the Board staff was in the process of developing a calculation of budget letter GRAA for fiscal year 1992 and beyond. Testimony at hearing established that the Board staff conveyed a description of the methodology to hospital representatives at that time. These actions suggested that the Board intended for the base GRAA for fiscal year 1992 to be calculated differently than the methodology used during the phase-in period. Not surprisingly, there is no agency precedent on this matter since these cases represent the first occasion on which 1992 budget letters were filed and reviewed. As noted earlier, a budget letter is appropriate when a hospital does not seek a rate of increase in GRAA in excess of the MARI for the hospital's next fiscal year. Whether the rate of increase in the GRAA is of such magnitude as to require detailed review is directly dependent on the manner in which the base GRAA is calculated, and this issue lies at the heart of the dispute. This is because the Board uses the results of the calculation (base GRAA x applicable rate of return) solely for the purpose of creating a so-called threshold GRAA, which if exceeded by the hospital's requested GRAA, triggers the need for detailed review. Thus, the calculation simply provides the Board with a means for determining whether the proposed increase in the GRAA falls within budget letter guidelines. 2/ In every case here, petitioners' GRAA exceeded the Board's threshold GRAA so as to trigger the need for a detailed budget. The Board's calculation of the base is done in a manner consistent with subsection 407.50(3). That subsection reads in pertinent part as follows: In determining the base, the hospital's prior year audited actual experience shall be used unless the hospital's prior year audited actual experience exceeded the applicable rate of increase in which case the base shall be the gross revenue per adjusted admission from the year before the prior year, increased by the applicable rate of increase for the prior year, and then inflated by the applicable rate of increase for the current year. Thus, the methodology requires that the prior year audited actual experience be used as the starting point unless such charges exceeded the applicable (approved) rate of increase. Although the parties agree that 1991 actual data would be the most desirable to use, that data is unavailable. Therefore, fiscal year 1990 results of operation, which are the most current audited actual experience, must necessarily constitute "the prior year audited actual experience" within the meaning of the statute. To determine whether the 1990 actual experience exceeded the applicable rate of increase, the Board measured the increase in the actual GRAA from 1989 to 1990. If the actual rate of increase did not exceed the approved rate of increase, the Board took the 1990 actual GRAA, inflated that amount by the applicable rate of increase for the current year (1991), and used the resulting number as the base GRAA. Conversely, if the 1990 actual GRAA exceeded the 1989 approved GRAA by more than the authorized rate, the Board used the 1989 actual GRAA (the gross revenues from the year before the prior year) inflated by the 1990 MARI, as further increased by the applicable rate of increase for the current year (1991) to produce the GRAA base. The Board has used the above described methodology for several reasons. First, it found nothing in subsection 407.50(2) which calculated a base for budget letter submissions. Indeed, the word "base" is found only in subsections 407.50(1) and (3), and by its own terms the former subsection does not apply to 1992 budget letter filings. Thus, the Board calculated the base in accordance with the method prescribed in subsection (3). Second, prior to the change in the law in 1988, the budget review process was "budget-based" in contrast to the present process which is tied to actual rates of increase. In other words, under the "old" process, the Board compared a budget under review with a prior budget number while the "new" process compares the budget under review with prior actual numbers. The Board's methodology is consistent with this philosophy and ties the base measurement to actual experience rather than estimated or budget figures. Third, for budget years 1990 and 1991, hospitals did not incur a penalty for exceeding their GRAA. The Board now intends to impose a penalty should this threshold be exceeded by hospitals in 1992 budget year and beyond. The Board's methodology is obviously geared toward this type of review process. Fourth, if a hospital's actual charges are less than its budgeted GRAA, by increasing the budgeted GRAA by the MARI as petitioners propose, a hospital's actual rate of increase would be greater than the MARI. Under the Board's methodology, a hospital would be required to justify such an increase. Similarly, if the Board's methodology was not used, a hospital could file a budget letter certifying a maximum GRAA which exceeds the threshold GRAA under subsection 407.50(3), thereby circumventing the detailed review process. Such a result should be avoided since to do otherwise would create an internal conflict within the terms of section 407.50 and would be contrary to the Board's mission under the law, as expressed in subsection 407.003(3)(a), which is to "contain hospital charges that exceed certain thresholds". Finally, Board experience shows that it is not unusual for a hospital to have a wide variance between actual experience and budget. Indeed, as many as one half of all hospitals have a marked variation between actual results and budget projections. Because of this, the Board methodology is a reasonable way in which to take these variances into account in the budget review process. Collectively, these considerations support a finding that, while not perfect or ideal in every respect, the Board methodology is logical, reasonable and appropriate. Petitioners have lodged several objections to the methodology. First, they point out that seven of the fourteen petitioners went through detailed budget review during their last budget filing and were required to justify all matters in their 1991 budgets. Thus, they contend that if they do not agree with the Board imposed budget letter GRAA, they must undergo detailed review a second time for some items that were already reviewed and approved in the prior budget year. However, the greater part of the review here will be of new projections for 1992 which were not included in the 1991 budget. Therefore, there will be little, if any, redundancy in the process. Moreover, detailed review is called for whenever a hospital seeks a rate of increase greater than its MARI even if this occurs in consecutive budget years. Secondly, petitioners contend that two hospitals were penalized by the use of the methodology simply because they had less charges than were budgeted. In other words, when actual results of operations became available, two hospitals learned that their actual charges were less than their budgeted charges. 3/ This resulted in at least one hospital receiving a smaller budget letter GRAA in 1992 than it had in 1991. Petitioners characterize this as a "perverse incentive" since the Board's methodology seemingly encourages a hospital to increase its charges to the budgeted level to avoid having its charges reduced in future years. However, the legislature recognized this anomaly by providing that if a hospital's GRAA increased at a rate of increase lower than its MARI, it would receive "banked" percentage points which it could carry forward in the form of credits to subsequent budget years. In these cases, no hospital elected to use banked credits. Then, too, if a hospital desires a greater rate of increase (and concomitant larger GRAA), it has the statutory mechanism to justify that increase through the detailed budget review process. Similarly, for those hospitals that exceed their budget, and under the Board's methodology are faced with a future reduction in revenue caps, they need only justify those excess charges in the detailed review process in order to avoid this dilemna. Petitioners also criticize the methodology because it does not consider the budget GRAA from the previous fiscal year even though a hospital has already gained approval to operate at the prior year budget level. However, this argument fails to recognize that the use of actual data over budget data is preferred since budgets are merely projections that are often times not attained. Petitioners next point out that the current detailed budget review scheme now codified in Chapter 10N-5, Florida Administrative Code, was not adopted until after subsection 407.50(3) became law in 1988. Thus, they suggest that the word "base" in subsection (3) represents a statutory directive to use a GRAA base specific to detailed budget review. However, the rules in question implement subsections 407.05(6) and 407.50(6) rather than subsection 407.50(3), and the challenged base GRAA calculation is not used during that subsequent detailed budget review process. In other words, even though subsection (3) pertains generally to detailed budget review and provides a calculation of a "base", the Board has opted to use a different methodology found in chapter 10N- 5 in the detailed review process. Although the legislature amended the law in both 1989 and 1991, it chose not to disturb this process or otherwise limit the Board's authority to continue to apply those rules. Therefore, the Board's rejection of petitioners' interpretation is found to be persuasive. Finally, it should be recognized that fiscal years 1990 - 1992 are so-called transition years after the major substantive changes in the law in 1988 and it is not unexpected to have some unusual cases arise. While petitioners have cited a few such cases occurring in budget year 1992, the appropriate remedy is to explain and justify these abnormalities through the detailed review process. Accordingly, these criticisms are found to be without merit. Alternative Proposals Petitioners have proposed three alternative methodologies to calculate the base. They are identified as alternatives 2, 3 and 4 on page 2 of joint composite exhibit 1. 4/ Petitioners assert their alternatives most accurately reflect the GRAA from the previous fiscal year and thus are in compliance with the language in subsection 407.50(2)(a) that requires a hospital to acknowledge its applicable rate of increase in its GRAA "from the previous fiscal year". Accordingly, in formulating their methodologies, petitioners have relied heavily on the words "previous fiscal year" and in some form or fashion have tied all of their calculations to the year 1991. Under petitioners' proposal, a hospital could presumably choose from one of the three alternatives depending on which one was best suited to that hospital's financial circumstances. Petitioners have first proposed to calculate the base by taking the 1990 actual GRAA and inflating it by the 1991 MARI. They contend that this alternative is reasonable because it uses the most recent actual data (1990) as well as reliable numbers (1991 MARI). While this methodology is the same as the Board's methodology for those hospitals whose 1990 actual GRAA did not exceed their 1990 budget GRAA, petitioners do not propose to use it in that manner. Rather, they intend to use it to calculate the base GRAA for two hospitals whose 1990 actual results exceeded budget projections. By doing so, however, those hospitals would be allowed to circumvent the otherwise required detailed review process. Secondly, petitioners suggest that the 1991 budget GRAA be used as the base for calculating a 1992 budget GRAA. This methodology was apparently designed for seven hospitals which underwent detailed budget review during the last fiscal year. Petitioners contend this formula is reasonable because the 1991 budget GRAA has already been approved by the Board, and the seven hospitals had extensive review of last year's budgets. Even so, there is nothing that prohibits detailed review, if warranted, in consecutive budget years, and in any event, actual data is generally preferred over budget projections. Lastly, petitioners propose that the same methodology described in subsection 407.50(1) and used for budget years 1990 and 1991 be used again on the theory that if it was reasonable in those years, it is still reasonable to use now. This methodology calls for the higher of fiscal year 1990 actual GRAA inflated by the 1991 MARI or 1991 budget GRAA to be used as the 1992 base GRAA. Pursuant to the methodology, five hospitals have used the 1991 budget letter GRAA as their 1992 base GRAA. However, by its own terms the methodology used in subsection 407.50(1) is specifically limited to budget years 1990 and 1991, and the law contemplates a change in the calculation of the base in all subsequent budget years. Moreover, the use of actual versus projected numbers is to be favored. In short, then, while the three methods arguably have some beneficial features, they still do not have all of the favorable attributes found in the Board's methodology.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered by the Board confirming that petitioners' budget letters should be rejected as being non-conforming. DONE and ORDERED this 16th day of October, 1991, at Tallahassee, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 16th day of October, 1991.
Conclusions Having reviewed the four Notices of Intent to Deny Application issued May 13-18, 2010, attached hereto and incorporated herein (Ex. 1, 2, 3, and 4), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 5) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. The Petitioner shall remit to the Agency, within thirty (30) days of the entry of a Final Order adopting this agreement, an administrative fee in the sum of thirty thousand dollars ($30,000.00) to resolve the Agency's allegations of unlicensed activity, in the interest of expediently resolving these matters and in recognition of the expense and uncertainty of litigation. 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this case number, should be sent directly to: Filed January 10, 2012 1:47 PM Division of Administrative Hearings Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 4. Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. 5. Any requests for an administrative hearing are withdrawn. The parties shall bear their own costs and attorney’s fees. This matter is closed. DONE and ORDERED this [0 day of ~ Bettie: ; 20/2, in Tallahassee, Leon County, Florida. — Ds we { izabeth Dudek, retary fey ir wacked 0. th€are Administration A PARTY WHO JS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Lance P. Cohen, Esquire Warren J. Bird, Asst. General Counsel Cohen & Thurston, P.A. Office of the General Counsel 1723 Blanding Boulevard, Suite # 102 Agency for Health Care Administration Jacksonville, Florida 32310 2727 Mahan Drive, Bldg #3, MS #3 (U. S. Mail) Tallahassee, Florida 32308 (Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Roger Bell Health Care Clinic Unit Manager Agency for Health Care Administration 2727 Mahan Drive, MS #53 Tallahassee, Florida 32308 (Interoffice Mail) Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 (Interoffice Mail) Suzanne F. Hood Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the oa above-named person(s) and entities by U.S. Mail, or the method designated, on this the 10 day of aaa » 2012" Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 412-3630 Certified Article Number , ?bbO 390) Y5778 8971 SEMDERS RECORD i", Certified Article Number (?160 3901 9846 7935 1337 SENDERS RECORD One Nofice $1149/1° CHARLIE CRIST FIORDAAGENCY FOR HEATH CARE ADMINS TRATION Better Health Care for ail Floridians THOMAS W. ARNOLD GOVERNOR SECRETARY May 12, 2010 Physicians Medical Centers - Jax Inc File Number: 8428 1680 Dunn Ave Case #: 2010004935 Ste 39 Jacksonville, FL 32218 F INTENT TO DENY APP TION It Is the decision of this Agency that the application for certificate of exemption from health care clinic licensure for Physicians Medical Centers - Jax Inc, located at 1680 DUNN AVE, STE 39, JACKSONVILLE, FL, 32218, be DENIED. The specific basis for this determination is based on the fact that: Requested information was not complete or timely received by the Agency pursuant to Section 408.806(3)(b), Florida Statutes. You were notified by correspondence dated April 9, 2010 to provide further Information addressing identified apparent errors or omissions within twenty-one days (21) from the receipt of the Agency's correspondence. Our records indicate you received this correspondence by certified mail on April 15, 2010. The outstanding issues remaining are: A copy of the closing documents, stock or similar certificates signed and dated by both the buyer and seller is required, In addition, the Agency received information that the facility does not meet exemption requirements as it is not wholly owned by a Florida licensed health care practitioner, pursuant to Section 400.9905(4)(g). EXPLANATION OF RIGH Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. ce: Agency Clerk, Mail Stop 3 ; Legal Intake Unit, Mall Stop 3. EXHIBIT 14 Visit AHCA online at http://ahca.myflorida.com 2727 Mahan Drive,MS-53 Tallahassee, Florida 32308 " Certified Article Number , 7260 3901 9648 57748 8995 SENDERS RECORD FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST THOMAS W. ARNOLD GOVERNOR Better Health Care for all Floridians SECRETARY May 12, 2010 Physicians Medical Centers - Jax Inc File Number: 8430 9826 San Jose Blvd Case #: 2010004881 Jacksonville, FL 32257 .. : NOTICE OF INTENT TO DENY APPLICATION It is the decision of this Agency that the application for certificate of exemption from health care clinic licensure for Physicians Medical Centers - Jax Inc, located at 9826 San Jose Bivd, Jacksonville, FL, 32257, be DENIED. The specific basis for this determination is based on the fact that: Requested information was not complete or timely received by the Agency pursuant to Section 408.806(3)(b), Florida Statutes. You were notified by correspondence dated March 27, 2010 to provide further information addressing identified apparent errors or omissions within twenty- one days (21) from the receipt of the Agency's correspondence. Our records indicate you received this correspondence by certified mail on April 8, 2010, The outstanding issues remaining are: Subpart 1.B, Name-of.Applicant: The name of the applicant must be the corporation or legal entity as it is registered with. the Division of Corporations, it must also match-the FEIN indicated in section 1.C. This subpart was submitted as a response to the omissions, but the. applicant's name indicated does not match the FEIN# listed in section 1.C. of the application. : As this facility did a change of ownership, provide a copy of the closing documents signed and dated by both the buyer (new owner) and seller (previous owner). Acceptable documentation may include any one of the following: Copy of final sale/transfer documents showing date of final transfer and signatures of buyer(s) and seller(s), or a signed, written statement from an attorney, on letterhead, that confirms sale/transfer completion and provides the date of final action. : In addition, the Agency received information that the facility does not meet exemption requirements as it is not wholly owned by a Florida licensed health care practitioner, pursuant to Section 400.9905(4)(g). TION OF HT! Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing, In order to obtain a formal proceeding before -the Division of Administrative Hearings under Section 120,57(1), F.S., your request for an administrative hearing-must conform to the - requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. ; : : Visit AHCA online at http://ahca.myflorida,com 2727 Mahan Drive,MS-53 Tallahassee, Florida 32308 EXHIBIT 2 Physicians Medical Centers -. . Inc Page 2 : May 12, 2010 SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. ce: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 Te thictee-Va thet [9 Number fd60 3901 9848 7495 a2, SENDERS RECORD FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST THOMAS W. ARNOLD GOVERNOR Better Health Care for all Floridians SECRETARY May 13, 2010 Physicians Medical Centers - Jax Inc File #8427 5960 Beach Blvd : Case #2010004956 Ste3 ; Jacksonville, FL 32207 NOTICE OF INTENT TQ DENY APPLICATION It is the decision of this Agency that the application for certificate of exemption from health care clinic licensure for Physicians Medical Centers - Jax Inc, located at 5960 Beach Bivd., Ste 3, Jacksonville, FL, 32207, be DENIED. The specific basis for this determination is based on the fact that: Requested information was not complete or timely received by the Agency pursuant to Section 408.806(3)(b), Florida Statutes. You were notified by correspondence dated April 7, 2010 to provide further information addressing identified apparent errors or omissions within twenty- one days (21) from the receipt of the Agency's correspondence. Our records indicate you received this correspondence by certified mail on Apri! 9, 2010. The outstanding issues remaining are: As this facility did a change of ownership, provide a copy of the closing documents signed and dated by both the buyer (new owner) and seller (previous owner). Acceptable documentation may include any one of the following: Copy of final sale/transfer documents showing date of final transfer and signatures of buyer(s) and seller(s), or a signed, written statement from an attorney, on letterhéad, that confirms sale/transfer completion and provides the date of final action. ; In addition, the Agency received information that the facility does not meet exemption requirements as it is not wholly owned by a Florida licensed health care practitioner, pursuant to Section 400.9905(4)(g). EXPLANATION OF RIGHTS Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. EXHIBIT 3 Visit AHCA online at http://ahca.myflorida.com 2727 Mahan Drive,MS-53 Tallahassee, Florida 32308 Physicians Medical Centers - Jax Page 2 May 13, 2010 SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. Health Cae Clinic Unit ce: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 RTE ecm 3901 94a 7935 yy74 SENDERS RECORD FLORIDA AGENCY TOR HEALTH CARE ADMINISTRATION oe ERNGS Better Health Care for all Floridians THOMAS W. ARNOLD May 18, 2010 CERTIFIED MAIL / RETURN RECEIPT REQUESTED File Number: 8429 Physicians Medical Centers - Jax, Inc 2020 Kingsley Ave Case #: 2010005135 Suite A Orange Park, FL 32073 NOTICE OF INTENT TO DENY APPLICATION It is the decision of this Agency that the application for certificate of exemption from health care clinic licensure for Physicians Medical Centers - Jax Inc, located at 2020 Kingsley Avenue, Suite A, Orange Park, Florida, 32073 be DENIED. The specific basis for this determination is based on the fact that: Requested information was not complete or timely received by the Agency pursuant to Section 408.806(3)(b), Florida Statutes, You were notified by correspondence dated April 9, 2010 to provide further information addressing identified apparent errors or omissions within twenty-one days (21) from the receipt of the Agency’s correspondence, Our records indicate you received this correspondence by certified mail on April 12, 2010, The outstanding issues remaining are: Evidence of Ownership — Information received by the Agency states that Victoria Critzer is the owner of Physicians Medical Centers-Jax Inc. Provide the following documentation as evidence of ownership: * A copy of the final closing documents such as a bill of sale or stock purchase agreement. signed and dated by both the buyer and seller including the effective date sale or transfer. The closing documents should contain the signature of Gordon Garver DC, previous owner of Physicians Medical Center-Jax Inc and Joseph Thomas MD, new owner of Physicians Medical Center-Jax Inc. ¢ A copy of the cancelled and reissued stock certificates transferring shared to Joseph Thomas MD. ¢ Acopy of the lease agreement that includes the name(s) of the owner(s). e Acopy of the business tax receipt that includes the name of the corporation and owner. In addition, the Agency received information indicating that the facility does not meet exemption requirements as it is not wholly owned by a Florida licensed health care practitioner, pursuant to Section 400.9905(4)(g). EXHIBIT 2727 Mahan Drive,MS-53 Tallahassee, Florida 32308 Visit AHCA online at http://ahca.myflorida.com . Physicians Medical Centers - Ja... .nc Page 2 May 18, 2010 EXPLANATION OF RIGHTS Pursuant to Section 120,569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S. your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. ey SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS, For questions regarding this notice, please contact Ruby Schmigel, Health Services & Facilities Consultant with the Health Care Clinic Unit at (850) 412-4413. oger Bgl, Mandger Health Care Clinic Unit ce: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PHYSICIANS MEDICAL CENTERS-JAX, INC., Petitioner, DOAH Case Nos. 10-3202, 10-3203, 10-3204 and 10-3205 vs. AHCA CASE Nos.: 2010004881, 2010004956 AGENCY FOR HEALTH CARE 2010004935 and 2010005135, ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Physicians Medical Centers- Jax, Inc. (hereinafter “Petitioner”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Petitioner applied for four certificates of exemption from licensure pursuant to Section 400.9935(6), Florida Statutes and Chapter 59A-33, Florida Administrative Code; and WHEREAS, Victoria Critzer has applied for four initial health care clinic licenses, expressly intending to purchase the interest of Dr. Joseph Thomas in Petitioner upon issuance by the Agency of those licenses; and WHEREAS, the Agency has jurisdiction of the license and exemption applications described in the foregoing paragraphs, by virtue of being the regulatory and licensing authority over the said licenses and exemptions; and EXHIBIT 5 WHEREAS, the Agency served the Petitioner with four Notices of Intent to Deny Application on or about May 13, 2010, notifying the Petitioner of the Agency’s intent to deny the certificates of exemption for the reasons stated thereon, in Agency cases numbered 2010004881, 2010004956, 2010004935 and 2010005135; and WHEREAS, Petitioner timely requested a formal hearing pursuant to Section 120.57(2), Florida Statutes, and in response to said request the matters were forwarded to the Division of Administrative Hearings (DOAH), and were designated as cases numbered 10-3202, 10-3203, 10-3204 and 10-3205 in that tribunal; and subsequently the parties agreed to, and did abate those cases in DOAH, for the purpose of discussing settlement; and WHEREAS, the Agency alleges, and Petitioner denies, that during the period of processing of the aforementioned applications, Petitioner operated one or more unlicensed health care clinics in violation of Florida law as to which no formal administrative, civil or criminal action has thus far been brought; and WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the parties stipulate to the adequacy of consideration exchanged; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement of these proceedings; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Joseph Thomas, M.D. hereby acknowledges, affirms and certifies that, at the time this agreement is executed by him, he is the sole owner of the Florida corporation Physicians Medical Center-Jax, Inc. 4, Victoria Critzer hereby acknowledges, affirms and certifies that, at the time this agreement is executed by her, she is the sole owner of the Florida corporation Physicians Medical Center, Inc. 5. Upon full execution of this Agreement, Petitioner agrees to waive any and all proceedings and appeals to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction; and further agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, that no Agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. 6. Upon full execution of this Agreement, the parties agree to the following: a. Petitioner's four (4) applications for exemption from licensure are hereby withdrawn, and Petitioner expressly waives its right to challenge or appeal, or both, in DOAH or elsewhere, the denial by the Agency of the exemptions. b. The Agency will resume processing the four initial licensure applications submitted by Victoria Critzer as intended future 100% owner of Physicians Medical Centers-Jax, Inc., now pending, and if the applications are complete and the applicant qualified under applicable law, the Agency will issue the licenses upon full payment by Petitioner of an agreed upon sum, as set forth below, to resolve the Agency's claim of unlicensed activity against Physicians Medical Center, Inc. Ms. Critzer agrees to use reasonable diligence to timely remedy any omissions from the applications cited by the Agency, to make the facilities available as required by law for all inspections required in connection with the licensure of the facilities, and to otherwise comply with all requirements of the application process, and all statutes and administrative rules thereunto appertaining, including background screening as may be applicable. c. The Agency agrees to use all reasonable diligence to process the initial license applications, and to issue the initial licenses as expeditiously as reasonably possible, provided that Ms. Critzer timely complies with all reasonable requests for additional information to which the Agency is entitled as a component of the application and licensure process, and provided that Victoria Critzer, and the applications she presented, are qualified for the licenses under all applicable statutes and administrative rules. d. Victoria Critzer will maintain the health care clinic license #HCC6732 currently held by Physicians Medical Center Inc. (PMC), for purposes of billing health care services provided solely at the licensed location, 9826 San Jose Boulevard, Suite B, Jacksonville, Florida. Whereas, Ms. Critzer, through counsel, has advised the Agency of a change of address for the license from 9826 San Jose Boulevard, to 9826 San Jose Boulevard, Suite B, PMC will submit a change of address application to the Agency together with the appropriate fee, within 10 days of execution of this agreement, and prior to resumption by the Agency of processing of the subject licensure applications. The license will be maintained 7. under a different federal employer identification number from any other licenses issued to Victoria Critzer or any entity in which she has a controlling interest. A separate health care clinic license must be obtained for any other location at which any health care services will be provided and third-party reimbursement sought for on behalf of Physicians Medical Centers Inc. e. Physicians Medical Centers, Inc. agrees to pay the sum of thirty thousand and no/100s dollars ($30,000.00) to the Agency, to resolve the Agency's allegations of unlicensed activity, in the interest of expediently resolving these matters and in recognition of the expense and uncertainty of litigation. The sum will be paid in lump sum at the time that the initial licenses referenced in paragraph b., above, are issued, or within 30 days following rendition of a Final Order by the Agency that incorporates this Agreement, whichever occurs first. f. Nothing in this Agreement shall prohibit the Agency from denying Petitioner’s application for licensure based upon any statutory and/or regulatory provision, including, but not limited to, the failure of Petitioner to satisfactorily complete a survey reflecting compliance with all statutory and rule provisions as required by law. By executing this Agreement, the Petitioner neither admits nor denies the allegations raised in the Notices of Intent to Deny referenced herein. 8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating this Agreement in its entirety, and closing the above-styled case(s). The cases resident in DOAH, referenced above as DOAH cases numbered 10-3202, 10-3203, 10- 3204 and 10-3205, are currently closed by Order entered in that tribunal on October 7, 2010. The parties hereby further agree that those cases shall remain closed permanently, and each party hereby waives its right to seek to have any of those cases re-opened. 9. Each party shall bear its own costs and attorney’s fees. 10. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 11. The Petitioner for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the Agency and its agents, representatives, and attorneys of all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this Agreement, by or on behalf of the Petitioner or related or resulting organizations. 12. This Agreement is binding upon all parties herein and those identified as a party, or a beneficiary, of the provisions of this Agreement, and each signatory acknowledges same and the adequacy of consideration therefor. 13. In the event that Petitioner is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not prohibit the Agency from taking action regarding Petitioner’s Medicaid provider status, conditions, requirements or contract. 14. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. Both parties have been represented by counsel in the negotiation and execution of this Agreement. The Petitioner fully understands that counsel for the Agency represents solely the Agency and Agency counsel has not provided legal advice to or influenced the Petitioner in its decision to enter into this Agreement. 15. This Agreement contains the entire understandings and Agreements of the parties. 16. | This Agreement supersedes any prior oral or written Agreements between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 17. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 18. ‘Ifa court of competent jurisdiction finds any part of this Agreement to be void, voidable, or unenforceable, then the remainder of the contract shall remain in full force and effect. 19. All parties agree that a facsimile signature suffices fe 20. The following representatives and beneficiaries hereby ae duly S. to enter into this Agreement. Molly McKéns eputy Secretary {_ panes P. Céhen, Esquire Health Quality ance Cohen & Thurston, P.A. Agency for Health Care Administration 1723 Blanding Boulevard, Suite 102 2727 Mahan Drive, Bldg #3 Jacksonville, Florida 32310 Tallahassee, Florida 32308 Counsel to Petitioner DATED: (frolir DATED: 1-1 U~ aye William R. Roberts Acting General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: /7 [(3l 4 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: Uf (5) WH Physicians Medical Centers-Jax, Inc. 9826 San Jose Boulevard Jacksonville, Florida 32257 patep: _})-14~!/ ~~ x. 1 _f- Victoria Critzer as president, sole director and 100% Owner Physicians Medical Center, Inc. 9826-B San Jose Boulevard Jacksonville, Florida 32257 DATED: _|1- (4-//
Other Judicial Opinions A party who is adversely affected by this final order is entitled to judicial review pursuant to Sections 120.68 and 766.311, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing the original of a notice of appeal with the Agency Clerk of the Division of Administrative Hearings and a copy, accompanied by filing fees prescribed by law, with the appropriate District Court of Appeal. See Section 766.311, Florida Statutes, and Florida Birth-Related Neurological Injury Compensation Association v. Carreras, 598 So. 2d 299 (Fla. 1st DCA 1992). The notice of appeal must be filed within 30 days of rendition of the order to be reviewed.
The Issue The issue in this cause is whether the prerequisites of Section 154.314, Florida Statutes, have been met. That section governs withholding of funds due to the county under revenue sharing or tax-sharing in order to forward said funds to a regional referral hospital to compensate the hospital for services rendered to an out-of-county indigent patient. Specifically, the parties stipulated and agreed that all prerequisites had been met except whether Tallahassee Memorial Regional Medical Center exhausted its administrative and legal remedies, as provided in Chapter 120, prior to certifying to the Comptroller's Office the amount due from Suwannee County. Suwannee County presented the testimony of Frank C. Davis and had one exhibit admitted in evidence. The Department of Banking and Finance (Department) had one exhibit admitted into evidence. Tallahassee Memorial Regional Medical Center (TMRMC) had six exhibits admitted into evidence. The Department waived the filing of a proposed order. Suwannee County and TMRMC submitted proposed findings of fact and conclusions of law. All proposed findings of fact and conclusions of law have been considered. A ruling has been made on each proposed finding of act in the Appendix attached hereto and made a part of this Recommended Order.
Findings Of Fact TMRMC is a regional referral hospital located in Tallahassee, Leon County, Florida. From May 15, 1985, to July 2, 1985, TMRMC provided medical care to Doris M. Cherry. The total bill for these services was $68,182.75. On July 10, 1985, TMRMC wrote to Suwannee County and requested reimbursement in the amount of $3,827.83 for the treatment rendered to Doris M. Cherry. This amount represented the maximum reimbursement which can be sought under Section 154.306, Florida Statutes. Reimbursement is limited to payment for 12 days of services at the per diem reimbursement rate currently in effect for the regional referral hospital under the medical assistance program to the needy under Title XIX of the Social Security Act. On July 23, 1985, Suwannee County, through its county coordinator, Frank C. Davis, refused TMRMC's request for payment and disputed whether the patient was entitled to the benefits under Chapter 154, Part IV. The letter from Suwannee County did not advise TMRMC of its right to request a formal hearing pursuant to Chapter 120 and it did not provide a point of entry as required in Rule 28-5.111(1), Florida Administrative Code. On December 20, 1985, TMRMC wrote to Suwannee County requesting an administrative proceeding to determine the issues and liability of Suwannee County to TMRMC for the claimed services. TMRMC also filed a formal Request for Hearing. TMRMC requested that the matter be referred to the Division of Administrative Hearings for a hearing to be conducted according to Section 120.57(1), Florida Statutes. Suwannee County failed to take any action on TMRMC's Request for Hearing. In an abundance of caution, TMRMC again wrote to Suwannee County on January 17, 1986, pointing out that no response had been received to the Request for Hearing and again requesting a hearing. TMRMC attached a copy of the Request for Hearing to this letter. As evidenced by the return receipt, the Board of County Commissioners received this letter on January 22, 1986. Suwannee County neither granted nor denied TMRMC's Request for Hearing. Instead, Suwannee County chose to ignore the request. The February 4, 1986, meeting of the Suwannee County Board of Commissioners shows that the Board voted unanimously to wait before responding to the request. No response was ever made. Suwannee county did not give written notice to TMRMC of their decision to ignore the request for hearing. TMRMC took no judicial action by mandamus or certiorari to enforce its right to a hearing. Further, TMRMC did not petition the District Court of Appeal for review of this matter. After waiting several months for a response from Suwannee County, on August 13, 1986, TMRMC certified to the Division of Accounting and Auditing, Comptroller's Office, the sum of $3,827.83 to be withheld from revenue-sharing or tax- sharing funds allocated to Suwannee County. The Department of Banking and Finance sent Its Notice of Intent to Withhold Funds to the Board of County Commissioners of Suwannee County on August 29, 1986. It was only in response to this action by the Comptroller's Office, acting through the Department of Banking and Finance, that Suwannee County requested a formal hearing. By its Request for Formal Hearing, Suwannee County attempted to raise and litigate the eligibility of Doris M. Cherry to the benefits of Chapter 154, Part IV. However, it is undisputed that these disputed issues the fact cannot be litigated in this proceeding because this hearing is limited in scope to determine only, if the prerequisites of Section 154.314, Florida Statutes, have been satisfied. Tallahassee Memorial Regional Medical Center, et al., v. Lewis, 399 So.2d 106 (Fla. 1st DCA 1981).
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Banking and Finance enter a final order determining that all prerequisites to Section 154.314, Florida Statutes, had been met and forward the amount certified to the Tallahassee Memorial Regional Medical Center from the revenue-sharing or tax-sharing funds due to Suwannee County. DONE AND ENTERED this 12th day of March, 1987, in Tallahassee, Florida. DIANE K. KIESLING 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 12th day of March, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-3901 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the proposed findings of fact submitted by the parties in this case. Specific Rulings on Proposed Findings of Fact Submitted by Petitioner Suwannee County Proposed findings of fact 1, 3, and 4 are rejected as unnecessary. Proposed finding of fact 11 is rejected as being unsupported by the competent, substantial evidence. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed findings of fact: 2(11); 5(1); 6(2); 7(3); 8(4); 9(5); 10(6); 12(9); and 13(10). Specific Rulings on Proposed Findings of Fact Submitted by Intervenor, TMC Proposed finding of fact 8 is rejected as being argumentative and conclusory. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(3); 2(4); 3(4); 4(4); 5(5 and 6); 6(7); 7(8); 9(10); and 10(9). COPIES FURNISHED: Walter W. Wood, Esquire Office of the Comptroller The Capitol, Suite 1302 Tallahassee, Florida 32301 Jesse F. Suber, Esquire Post Office Box 1049 Tallahassee, Florida 32302 Ernest A. Sellers, Esquire James W. Prevatt, Jr., Esquire Post Office Box 8 Live Oak, Florida 32060 Honorable Gerald Lewis Comptroller, State of Florida The Capitol Tallahassee, Florida 32301
The Issue Whether the Division of Administrative Hearings has jurisdiction to conduct a formal hearing under the provisions of Sections 120.569 and 120.57(1), Florida Statutes, if the Petition for Relief was not timely filed pursuant to Section 760.11(7), Florida Statutes. Whether the Division of Administrative Hearings has jurisdiction to conduct a formal hearing under the provisions of Sections 120.569 and 120.57(1), Florida Statutes, if the Florida Commission on Human Relations fails to send a copy of the Charge of Discrimination to Respondent within five days of the complaint being filed, as required by Section 760.11(1), Florida Statutes.
Recommendation Based on the foregoing facts and conclusions of law, it is RECOMMENDED that a final order be entered dismissing with prejudice the Petition of Manuel Pedraza in DOAH Case No. 02-0238, and FCHR Case No. 99-1636, for failure to timely file his Petition for Relief. DONE AND ENTERED this 21st day of June, 2002, in Tallahassee, Leon County, Florida. ___________________________________ DANIEL M. KILBRIDE 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 21st day of June, 2002. COPIES FURNISHED: Susan K. W. Erlenbach, Esquire Erlenbach Law Offices, P.A. 2532 Garden Street Titusville, Florida 32796 Toby Lev, Esquire Egan, Lev, & Siwica, P.A. Post Office Box 2231 Orlando, Florida 32802 Denise Crawford, Agency Clerk Florida Commission on Human Relations 2009 Apalachee Parkway, Suite 100 Tallahassee, Florida 32301 Cecil Howard, General Counsel Florida Commission on Human Relations 2009 Apalachee Parkway, Suite 100 Tallahassee, Florida 32301
