The Issue The issue is whether Respondent properly dismissed Petitioner's Petition for Resolution of Workers' Compensation Reimbursement Dispute, pursuant to section 440.13(7), Florida Statutes.
Findings Of Fact At all material times, C. G. was employed by Solo Printing, Inc., which had workers' compensation coverage through Intervenor. On March 2, 2012, C. G. was injured at work as a result of falling onto his knee during a fight with a coworker. C. G. was transported from the worksite by ambulance to Petitioner's hospital, where he was admitted. Later the same day, C. G. underwent emergency surgery to his knee. He was discharged from the hospital on March 8, 2012. On April 2, 2012, Petitioner billed Intervenor for services rendered to C. G. during his hospitalization. On May 11, 2012, Intervenor issued a Notice of Denial. On June 8, 2012, Petitioner filed with Respondent the Petition. On June 14, 2012, Respondent issued the Dismissal. Intervenor's Notice of Denial cites three grounds for denying payment for the bill: section 440.09(3), which prohibits compensation for injuries to an employee "occasioned primarily" by his willfully trying to injure another person; lack of authorization for services; and any other defense that may become available. The Dismissal cites one ground for dismissing the Petition: Petitioner's failure to submit an EOBR with its Petition. The only ground cited in the preceding paragraph that is relevant is the first cited by Intervenor. This ground raises the issue of compensability by disclosing that Intervenor has not conceded that C. G.'s injuries are compensable. Nor has a Judge of Compensation Claims (JCC) ever entered an order determining that C. G.'s injuries are compensable. In fact, G. has never filed a claim for benefits. At the time in question, C. G. had health insurance, but his insurer reportedly denied coverage on the ground that it insured's injuries were covered by workers' compensation. It does not appear that Petitioner has commenced a legal action against C. G. for payment for the services that it rendered to him in March 2012.
Recommendation It is RECOMMENDED that the Department of Financial Services enter a Final Order dismissing the Petition. DONE AND ENTERED this 25th day of February, 2013, 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 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 25th day of February, 2013. COPIES FURNISHED: Lorne S. Cabinsky, Esquire Law Offices of Lorne S. Cabinsky, P.A. Suite 1500 101 Northeast 3rd Avenue Fort Lauderdale, Florida 33301 Mari H. McCully, Esquire Department of Financial Services Division of Workers' Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 James T. Armstrong, Esquire Walton Lantaff Schroeder and Carson, LLP Suite 1575 200 South Orange Avenue Orlando, Florida 32801 Julie Jones, CP, FRP, Agency Clerk Division of Legal Services Division of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-0390
The Issue Whether Petitioner is entitled to the amounts claimed in the challenges to the IRR determinations as set forth in the cost settlement documents.
Findings Of Fact Petitioner, Sunrise Community, Inc., is a non-profit organization that offers assistance and support to people with developmental disabilities. It specializes in residential services but also provides day programs, supported living services, and other programs to assist people in the lower functioning ranges of mental retardation. Respondent, Agency for Health Care Administration, is the state agency charged with the responsibility of administering and supervising Medicaid reimbursements. At all times material to this cause, Petitioner was an authorized Medicaid provider. The quality of care provided by Petitioner and its facilities has never been disputed in this cause. The disputes in this matter arose due to challenges to the rates of reimbursement to Petitioner and its facilities. In Florida, Medicaid providers such as Petitioner are reimbursed on a prospective basis. Each provider gets a rate for reimbursement that is established based upon the actual allowable costs from a prior, fixed period of time which is then utilized to pay for a subsequent time period. For convenience of review this rate is sometimes thought of as the "budgeted rate" in this record. It assumes costs from past experience will be incurred in the future and provides for a known, fixed amount of compensation to hopefully cover such expenses. All Medicaid providers are required to disclose their actual costs for an entire reporting period. A cost report must be prepared using the accrual basis of accounting in accordance with generally accepted accounting principles as set forth in the rules governing Medicare reimbursement. After the fact, providers then "settle up" with the Agency by comparing the actual allowable costs incurred in the rate period with the rate. Providers cannot make a profit or excess revenue on the rate. Where a rate for a given period proves to be too low or inadequate, the cost settlement procedure is designed to adjust the amounts owed to cover the deficit funding. Thus each Medicaid facility receives a rate which must be "cost settled" separately based upon its actual allowable expenses. Petitioner and its related facilities are entitled to rates that will cover the actual allowable costs of doing business. Petitioner is not entitled to a profit nor is it required to operate at a loss. Should a provider be overpaid, that is, if it is established during cost settlement that the rate received by the provider was more than the actual allowable costs incurred for the rate period, then the provider "repays" the overage to the Agency. Otherwise, the rate is fixed for the time period it relates to unless an IRR is approved to increase the rate. IRRs are submitted to the Agency when a provider’s rate does not provide adequate compensation. An approved interim rate is to give assurance that the original rate can be adjusted to accommodate the new costs incurred by the provider. Approved interim rates are also cost settled after the rate period as with budgeted rates. In 1995 Petitioner sought approval of interim rate increases from the Agency. Such requests were denied by the Agency but successfully appealed by Petitioner. Thereafter, because the period governed by the rates had passed, the Agency sought to cost settle the amounts owed to Petitioner. When the Agency refused to remit the court-ordered interim rate Petitioner lost the amount of the rate increase as well as an opportunity for use of those funds during the pending cases. The parties attempted to resolve the amounts claimed by Petitioner through the cost settlement process. As to each denied claim, Petitioner sought an administrative review and the matter was forwarded to the Division of Administrative Hearings. IRRs are designed to give providers relief so that unanticipated costs can be reimbursed. This is important since laws may change which require providers to offer additional programs or services the costs of which are not encompassed in the budgeted rate in effect at the time of the change in law. At the time of settlement, if there is an overpayment of the difference between the approved interim rate and the actual allowable costs, the provider refunds the overpayment. Similarly, if there is an underpayment as a result of the actual allowable cost being greater than the interim rate, the provider is entitled to receive additional payment. Petitioner is entitled to additional payments. The amount of the payments is the center of the disputes in this cause. First, the Agency has refused to remit monies associated with interest payments on a bond issue. The Agency refused to include payment for the bond interest because it maintains that, while bond interest expense is an actual allowable cost incurred by Petitioner, it was reported twice in the cost reports. The bond interest disallowed is itemized in Petitioner's Exhibit 17. Such exhibit accurately lists the amounts that the Agency should have approved for the IRR cost settlements for the facilities listed. The bond interest is appropriately allocated to the facilities listed and was not claimed or duplicated by another entity for the periods noted. Thus each of the listed facilities should have received an adjusted rate with the bond interest cost included in the calculation. Secondly, Petitioner claims that had the Agency timely remitted the funds associated with the IRR, it would have had the benefit of those monies for the interim period of time. As such, it maintains it should be paid interest on the monies not paid. The basis for the lost interest claim arguably stems from the Medicare rule that allows interest in some situations. Florida historically has not remitted interest on underpayment amounts. In calculating the amounts owed to Petitioner, interest lost on the IRR was therefore disallowed. There is no provision governing the Florida Medicaid plan that specifies the payment of interest on a rate. A provider’s rate can be broken down into four cost components: operating, resident care, property, and return on equity. Had Petitioner received the full IRR it might have been given a "return of equity" or "use allowance." It might have resulted in a positive average equity. Petitioner has not established through credible evidence that factually this "return of equity" would have been applicable to the situations of the facilities affected by the IRRs. Speculation as to the financial posture of the facilities has not been deemed persuasive. The third dispute in this cause relates to the computation of the amounts owed for the Pablo facility. The Pablo facility incurred expenses over a 140-day period which were annualized over a 366-day period to compute the interim rate amount. In so doing, the Agency abandoned the methodology previously utilized to compute the rate owed and determined that the actual allowable costs in the subsequent period (which were known) had to be considered. Had the Agency used the established methodology it claims it would have overpaid the provider in the subsequent period. While mathematically accurate in this single example, such methodology has not been used except in this instance (when it benefited the Agency). The abandonment of the methodology also ignores the cost settlement process that is designed to reconcile amounts after the fact. The plan used by these parties recognizes the settlement process as the procedure by which all actual allowable costs are reconciled. If after having received an inflated rate the Pablo facility had owed monies back, such funds would have been remitted through the cost settlement process. Of course in this case, the Agency did not remit an increased rate so the crux of the problem is to resolve the dispute artificially as if from one point in time to another the rate had been appropriately increased. The settlement should have utilized the 140-day period to calculate the rate. That is, the per diem should have used the expense amount divided by 140 not 366 to compute the daily expense. The fourth disputed amount is the IRR for Country Meadows. The Agency has conceded that this IRR could have been granted with an accounting clarification. The final disputed amount relates to attorney's fees. Petitioner maintains it is entitled to include an amount of attorney's fees that is based upon a contingency fee agreement. Although the Agency does not dispute that providers may include attorney's fees as an allowable cost, it argues that such costs are not reported until incurred. Moreover, such costs must be what a prudent buyer would pay and relate to the IRR. In this instance the plan provides that: Implicit in any definition of allowable costs is that those costs do not exceed what a prudent and cost-conscious buyer pays for a given service or item. If costs are determined by AHCA, utilizing the Title XVIII principles of reimbursement, HCFA PUB 15-1 (1993), and this plan to exceed what a prudent buyer would pay, then the excess costs shall not be reimbursable under this plan. Attorney's fees are considered part of the operating component of the rate calculation. It is an administrative cost and is reported on a provider’s cost report as such. In selecting the attorneys to represent it, Petitioner did not interview applicants, solicit proposals, or inquire of other attorneys as to a reasonable fee for this type of representation. Petitioner presented no credible evidence of the reasonable fee for representation in this type of proceeding. Petitioner’s lead counsel served on its Board of Directors at the time the contingency fee agreement was entered into. The contingency fee agreement provided for an alternative method of payment in the amount of $250.00 per hour. The attorney's fee agreement provided, in pertinent part: The attorney’s fee shall be 40% of the total of all funds received as a result of the reversal of the wrongful denial of the interim rate request covering the period from the date of filing the interim rate request through the date of final settlement. The lawyer shall have no claim on the future value of the interim rate request past the date of settlement. If an appeal is required the fee shall be 50% instead of 40%. If, due to circumstances beyond the control of the parties to this fee agreement, such as changes in law, or constructions of law inconsistent with this agreement, including constructions of law that would not permit the reimbursement of attorney's fees to Sunrise Community, Inc., the parties agree that in no event shall the fee be less than a reasonable fee based on the hours of work multiplied by the rate of $250.00 per hour. The attorney's fee agreement was executed on October 25, 1995 on behalf of Sunrise Community, Inc. Such agreement did not name the facilities whose IRRs were governed by the agreement. The agreement did not specify how the attorney fee would be allocated among the providers who would be affected by the successful challenge to the IRR denials. The opinion of the First District Court of Appeal that upheld the IRRs and directed the Agency to grant them was entered on January 27, 1998.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a Final Order that grants the bond interest as claimed by Petitioner; denies the interest on unpaid IRR amounts; grants the amounts claimed by Petitioner for Pablo; grants the Country Meadows IRR; and denies the attorney's fees. DONE AND ENTERED this 30th day of December, 1999, in Tallahassee, Leon County, Florida. J. D. PARRISH 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 30th day of December, 1999. COPIES FURNISHED: Steven M. Weinger, Esquire Kurzban, Kurzban, Weinger & Tetzeli, P.A. 2650 Southwest 27th Avenue Second Floor Miami, Florida 33133 Steven A. Grigas, Esquire Agency for Health Care Administration Fort Knox Building 3 2727 Mahan Drive, Suite 3431 Tallahassee, Florida 32308-5403 Ruben J. King-Shaw, Director Agency for Health Care Administration 2727 Mahan Drive, Suite 3116 Tallahassee, Florida 32308 Julie Gallagher, General Counsel Agency for Health Care Administration Fort Knox Building 3 2727 Mahan Drive, Suite 3431 Tallahassee, Florida 32308
The Issue The issues to be resolved in this proceeding concern whether the Petitioner was subjected to a discriminatory employment action on account of her race (black) and her disability ("severe asthmatic"). See, Section 760.10, Florida Statutes.
Findings Of Fact The Respondent, GAB Business Services, Inc. (GAB), is an insurance adjusting firm engaged in the business of adjusting insurance claims on a nationwide basis. At times pertinent hereto, it maintained a number of offices in Florida, also called "branches", one of which was located in Jacksonville, Florida, at which the Petitioner was employed at times pertinent hereto. The Petitioner was hired in March of 1985 and worked until May 31, 1992, when she was terminated because of a reduction in force enacted on a company-wide basis. Brian Sigman was appointed Branch Manager of the Jacksonville office, where the Petitioner was employed, on November 15, 1989 and served there in that capacity until May 1, 1991. After arriving as Branch Manager, he tried to assign the Petitioner property claim files and she told him that she did not want to do property insurance claims but never gave as a reason that she had an illness or disability which precluded her from handling such claims. Rather, she informed Mr. Sigman that she had a hard time visualizing hidden, structural elements of a building, such as what was behind a building wall, and, therefore, had a difficult time adjusting property insurance claims. Because at the time, in 1989, Mr. Sigman had six adjusters working in the office, he was able to give property insurance claim files to other adjusters to handle and let the Petitioner handle only casualty claims as she desired. She never informed him that she was unable to handle property claims because of asthma or other medical problems and never applied during that time for an accommodation for a disability. Mr. Sigman became aware at some point during his tenure that the Petitioner was being treated for allergies, but she never informed him of the effect of her allergies, as it related to the question of her handling property claims. There had been approximately six or more adjusters in the office since the Petitioner became employed there in 1985. Consequently, because of her aversion to handling property insurance claims, the Petitioner had been typically permitted to adjust only casualty claims, even before Mr. Sigman's tenure, since there were sufficient other adjusters in the office to handle the property claims. Property insurance claims generally deal with losses to a building while casualty claims most frequently involve third-party losses. Thus, the vast majority of the Petitioner's experience in working for the Respondent involved the handling of only casualty claims, with very little experience handling property insurance claims. In March 1991, Mr. Almus Shivley became the Branch Manager of GAB in Tampa, Florida. The Tampa branch included under its authority offices in Ft. Myers, Sarasota, Lakeland, Gainesville, and Jacksonville. All of the offices outside of Tampa are satellite offices, and each has a Supervising Adjuster supervising that office. A Supervising Adjuster reports directly to Mr. Shivley. Mr. Sigman was a Supervising Adjuster when Mr. Shivley became the Branch Manager in Tampa. When Mr. Shivley took over as Branch Manager working out of the Tampa branch office in 1991, he learned that the Petitioner was only handling casualty claims. He learned of this when she was asked to work property insurance claims and she declined to do so. She explained that she had asthma, and that various materials and smoke usually attendant to fire damage claims and locations, would, she feared, aggravate her asthmatic condition. Mr. Shivley accepted her representations to this effect and allowed her, for the time being, to work only casualty claims. The testimony of Sheila King establishes that as recently as February 1990, when she and the Branch Manager met with the Petitioner to ask her to handle property claims, she had made no mention of the asthma condition. Mr. George Walsh is in charge of the national operations of GAB, as they concern equal opportunity, affirmative action, salary administration and other personnel-type functions involving human resources. Mr. Walsh was involved with the hiring of the Petitioner and established that the Petitioner made no mention of the fact that she had any disability during the pre-hiring interview. The application form which the Petitioner executed and filed at the time of her hiring in 1985 contained a question concerning whether she had any disability which would restrict her ability to perform the job. She specifically answered "no" to that question. Mr. Walsh thereafter had no contact with the Petitioner until October 31, 1991, when she filed a "disability survey" form with him. A disability survey is a request by an employee for a disability accommodation, which can only be granted by the home office of the Respondent corporation. Mr. Walsh established that this was the first time he had any knowledge that the Petitioner had any sort of handicap of disability. He stated in his testimony that her job was thereupon analyzed in great detail because her request "went directly to the heart of our business". That is, the Petitioner was requesting the accommodation of not having to perform property insurance claims adjusting, which is a major portion of GAB's business since GAB is in the sole business of adjusting property and casualty insurance claims. In any event, Mr. Walsh reviewed her request under the appropriate company policies and determined that the number of casualty assignments and the work that the company was receiving was on a severely-declining trend in the Jacksonville office and, indeed, nationwide. He determined, however, to grant the accommodation to the Petitioner but informed her that "we could not guarantee that there would be enough casualty work in the future to allow her to perform only casualty work and still be a productive member of the office." In May of 1992, Mr. Shivley, the Branch Manager, made a recommendation to his superiors with the Respondent that the working force in Jacksonville be reduced because of a severe decline in business in that office. Prior to May of 1992, when the reduction in force took effect, there were already only three employees working in Jacksonville. After the reduction in force, only Mike Robinson, the Supervising Adjuster, who managed that office, remained. Almost two years after the reduction in force, at the time of the hearing, Mr. Robinson is still the only GAB employee in the Jacksonville office. The Petitioner, a black female, and Mr. Clark, a white male, were terminated as part of the reduction in force. Numerous offices of GAB, other than the one in Jacksonville, had suffered substantial reductions in force. A few years previously, the company had employed approximately 5,000 adjusters nationwide; and at the time of the hearing in this proceeding, it employed fewer than 2,000 adjusters nationwide. The Petitioner, upon being advised of her termination due to the reduction in force, was not offered a transfer nor requested to relocate by the Respondent. She was, however, offered an employment position in the company's Atlanta, Georgia, branch office. Under regular and customary company policy, when employees are transferred, the company pays relocation expenses, where appropriate. Since the Petitioner herein was terminated, the Respondent was under no obligation to pay relocation expenses if she took the offered position in the Atlanta office. Nevertheless, the Atlanta branch office offered her $3,000.00 in relocation expenses. Further, the job offered was one which accommodated her stated disability, being an "inside liability adjuster" position, handling only casualty claims. That was the type of work which she was performing in Jacksonville at her own request. The Petitioner took the position that the relocation expenses were insufficient for her to afford to move and refused the offer of employment. It was eventually accepted by a white female, who accepted the same amount of relocation financial assistance that had been offered to the Petitioner. Further, when Mike Robinson, the Supervising Adjuster in the Jacksonville office, was transferred to that office from Dallas, Texas, a much more distant location than Atlanta, he was only offered and paid $1,000.00 in relocation expenses. Mr. Robinson is a white male. In addition to Mr. Robinson, the testimony of Ms. Sheila King, the Human Resource Officer (Personnel Manager) for the Florida offices of GAB, establishes that two other employees were given only $1,000.00 for moving expenses, a black male and a white male. In conjunction with the reduction in force, the Petitioner and the white male, Mr. Clark, were terminated from the Jacksonville office because the volume of business did not justify any employees, other than the Supervising Adjuster. At the time of the hearing, some two years after the reduction in force, no employees have been hired to replace them. In fact, no employees have been hired at all, because the business volume only justifies the presence of the Supervising Adjuster and clerical staff in that office. GAB's offices in Florida, other than Tampa, are satellite offices and each has a Supervising Adjuster supervising the business and the employees of that office. Each Supervising Adjuster reports to Mr. Shivley, the Branch Manager in the Tampa office. In the summer of 1991, Brian Sigman left his position as Supervising Adjuster in the Jacksonville office, leaving an opening. The Petitioner applied for that position, among other employees who sought the promotion. Mr. Shivley recommended to his superiors that Adjuster Nan Hendricks become the Supervising Adjuster to replace Mr. Sigman. He found that Ms. Hendricks was an extremely good adjuster, being a multi-line adjuster handling a large volume of both property and casualty claims. She was a good performer at the functions of marketing, public relations, and generating new business. A multi-line adjuster is one who can handle any type of claim assigned to the Respondent's offices. The two most numerous types of claims handled by GAB are property and casualty claims, as described above. In considering who to hire for that position and ultimately deciding on Ms. Hendricks, the Respondent and Mr. Shivley determined that the Petitioner had little experience as a multi- line adjuster, even though she was so licensed, because she had handled almost entirely casualty claims, because of her own request that she not be given property damage claims. The Supervising Adjuster has to supervise the quality of the work performed by all adjusters and employees at the office. If an adjuster cannot work a property insurance claim, then the adjuster can gain no relevant experience performing such claims adjustment. A Supervising Adjuster needs to have had experience in performing such claims adjustment and performing adjustments of all types of claims. Mr. Shivley testified to this effect, saying "the Supervising Adjuster has to supervise the quality of the work that's going out of the office. If she can't work a property file, and if she can't handle a property file, then she can't supervise one". There is a regular and normally-followed company policy that, in considering who to place in supervising adjusting positions, such a person has to have had substantial experience handling all types of claims handled by GAB. The Petitioner did not have that type of experience and thus although she was considered for the position, she was found not to be qualified for it. Further, the Petitioner's performance, and evaluations of her performance, showed deficiencies over the period of time she was employed in the Jacksonville office. She was deficient in the areas of marketing, public relations, and generating new business, which, when coupled with the fact that she had no real, substantial, property claim adjustment experience, showed that she was not qualified for the promotion. Nan Hendricks left the employ of GAB after a short time as Supervising Adjuster in the Jacksonville office. When she left in 1991, she left because she was dissatisfied with the work of the office in terms of the rapidly- declining volume of business and the fact that both the Petitioner and Mr. Clark were performing their work in a sub-standard fashion. When she left the employ of GAB, Mr. Shivley recommended to his superiors that the position be awarded to Mike Robinson, who was then working in the Dallas, Texas, office of GAB. Mr. Shivley had experience with Mr. Robinson's capacity and abilities to work in a multi-line adjustment position and with the quantity and quality of his knowledge and experience at the job. He found him well-qualified for the position of Supervising Adjuster, due partially to his extensive experience in multi-line adjusting. The Petitioner was considered for the position but was not deemed to be qualified because she did not have significant experience as a multi-line adjuster and did not meet the qualifications, as explained more particularly in the above Findings of Fact, concerning the decision to promote Nan Hendricks as Supervising Adjuster. There has been no showing that the decision to terminate the Petitioner or the decision concerning the manner and amount of offered payment of her re-location expenses, had she taken the Atlanta job, was motivated by any discriminatory intent on account of her race or disability. In fact, the Respondent amply demonstrated that the termination was due to a legitimate reduction in force caused by loss of business in the Jacksonville office. The Petitioner's position was not later filled by another employee. Nevertheless, the company, without being required to do so, voluntarily offered the Petitioner a position in its Atlanta office at no reduction in salary. This position would even accommodate her disability by allowing her to only process casualty claims, even though the Respondent had a legitimate basis for terminating the Petitioner without any recourse, due to the reasons justifying the reduction in force. Further, the two promotions, one accorded to Nan Hendricks, a white female, and one to Mike Robinson, a white male, of which the Petitioner complains, were given to those two employees based upon their superior job performance and superior experience in being able to handle all types of insurance claim adjusting work. The Petitioner was shown to clearly not be so qualified. The Respondent's lack of discriminatory intent in terms of the Petitioner's race or disability was further demonstrated by the fact that a white female, a white male, and a black male were only offered and paid $1,000.00 in re-location expenses, when they moved their place of employment to distant offices in the company, especially Mike Robinson, who transferred to Jacksonville, Florida, all the way from Dallas, Texas. The Petitioner, however, was offered $3,000.00 to relocate from Jacksonville, Florida, to Atlanta, Georgia, when the company was not even obligated to offer any relocation expense, since the Petitioner's job offer in Atlanta did not involve a company- required transfer. Rather, it was a job merely offered to accommodate the Petitioner and to assist her in obtaining employment when she had to be terminated from the Jacksonville office. It has simply not been demonstrated that any of the employment actions of which the Petitioner complains and which are delineated in the above Findings of Fact were motivated by any discriminatory motive directed at the Petitioner's race or disability.
Recommendation Based on the foregoing Findings of Fact, Conclusions of Law, the evidence of record, the candor and demeanor of the witnesses, and the pleadings and arguments of the parties, it is RECOMMENDED that a Final Order be entered by the Florida Commission on Human Relations dismissing the Petition in its entirety. DONE AND ENTERED this 11th day of October, 1994, in Tallahassee, Florida. P. MICHAEL RUFF 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 11th day of October, 1994. APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-4399 Respondent's Proposed Findings of Fact 1-17. Accepted, except to the extent that they differ or are subordinate to the Hearing Officer's findings of fact on the same subject matter. Petitioner's Proposed Findings of Fact The Petitioner's proposed findings of fact are stricken and rejected on the basis that they were not timely submitted and the motion requesting extension of time for their submission was substantially late. COPIES FURNISHED: Reginald Estell, Jr., Esquire 816 Broad Street Jacksonville, FL 32202 Kalvin M. Grove, Esquire FOX AND GROVE 360 Central Avenue, 11th Floor St. Petersburg, Florida 33701 Sharon Moultry, Clerk Human Relations Commission Building F, Suite 240 325 John Knox Road Tallahassee, FL 32303-4149 Dana Baird, Esquire General Counsel Human Relations Commission Building F, Suite 240 325 John Knox Road Tallahassee, FL 32303-4149
Findings Of Fact By Administrative Complaint issued August 13, 1990, Petitioner charged Respondent with violation of Chapter 400, Part II, Florida Statutes and provisions of Rule Chapter 10A-5, Florida Administrative Code, due to Respondent's failure to correct five Class III deficiencies cited during a survey of Respondent's premises by Petitioner's representative on March 6, 1990. Respondent holds license number 0005512, issued by Petitioner or its predecessor, the Department of Health and Rehabilitative Services. Respondent's representative requested an administrative hearing on August 28, 1990. By joint stipulation between Respondent's representative and Petitioner's counsel, bearing a date stamp of February 13, 1991, the parties resolved their differences. As a result, the pending administrative proceeding before Hearing Officer Robert Benton, a duly designated representative of the Division of Administrative Hearings, was concluded. Under provisions of the stipulation between the parties, Respondent agreed to pay a fine of $937.50 through monthly payments to Petitioner of $156.25 for a period of six months beginning March 1, 1991. In the event of non-payment, Respondent agreed that it would be in default of a final order requiring payment of the entire fine amount. A final order incorporating the parties' stipulation was entered by Petitioner on March 16, 1991, directing the parties' compliance with the stipulation and its requirements that Respondent make the required monthly payments to prevent a default declaration. Respondent never made any payments, monthly or otherwise. On April 1, 1991, Respondent applied for a renewal of it's license to operate an adult congregate living facility. Thereafter the requested license renewal for the period of July 2, 1991 through July 1, 1993, was erroneously granted by Petitioner's representatives, contrary to the prohibition against such a renewal contained in Section 400.417(1), Florida States, and without regard to Respondent's noncompliance with Petitioner's final order of March 16, 1991. Respondent was informed by certified mail letter dated July 2, 1991, from Petitioner's counsel that no payment had been made pursuant to the parties's stipulation or the March 16, 1991, final order of Petitioner directing the parties' compliance with the terms of the stipulation. Respondent was requested to respond within 30 days. Respondent's representative received the letter on July 8, 1991. Petitioner's counsel, by certified mail, again notified Respondent on August 19, 1991, that no payment had been received and requested a response within seven days. Respondent's representative received the letter on August 21, 1991. On May 6, 1992, Petitioner issued the Administrative Complaint which forms the basis of this proceeding and declares that Petitioner is in default of the requirements of the parties' stipulation and subsequent final order. As requested relief, Petitioner seeks the revocation of Respondent's license in lieu of payment of the stipulated fine. Respondent's representative received the Administrative Complaint on May 8, 1992. At the final hearing, Respondent's representative and corporate officer, candidly admitted that it was his signature, on behalf of Respondent, on the original stipulation between the parties. He further stated that he never intended to pay anything toward retirement of the stipulated fine amount and that his execution of the stipulation was purely for the purpose of delay. He was motivated to seek delay in this manner because his wife was eight months pregnant and his brother was a political candidate for city commissioner at the time.
Recommendation Based on the foregoing, it is hereby RECOMMENDED that a final order be entered requiring Respondent to satisfy the March 16, 1991 final order by payment of the $937.50 fine by a date certain or suffer the immediate revocation of license number 0005512 without further proceedings. DONE AND ENTERED this 1st day of February, 1993, in Tallahassee, Leon County, Florida. DON W. DAVIS 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 1st day of February, 1993. APPENDIX The following constitutes my ruling pursuant to Section 120.59, Florida Statutes, on proposed findings of fact submitted by the parties. Petitioner's Proposed Findings 1.-11. Accepted. Respondent's Proposed Findings None submitted. COPIES FURNISHED: Michael O. Mathis, Esquire Agency for Health Care Administration General Counsel's Office 2727 Mahan Drive, Suite 103 Tallahassee, Florida 32308 Mark K. Glaeser, Pro Se Collins Court 2924 SW 39th Avenue Gainesville, Florida 32608 Sam Power Agency Clerk Agency For Health Care Administration The Atrium, Ste. 301 325 John Knox Road Tallahassee, FL 32303 Harold D. Lewis, Esquire General Counsel Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, FL 32303
