Findings Of Fact Petitioner, Palm Beach-Martin County Medical Center, Inc. (PBMCMC), owns and operates Salhaven Home Health Agency (Salhaven), a home health agency in Palm Beach County, Florida. Salhaven is licensed by respondent, Department of Health and Rehabilitative Services (HRS), to provide home health services in Palm Beach County. This authority was obtained in 1984. At the same time it obtained Medicare provider number 10-7203 effective August 10, 1984 from the United States Department of Health and Human Services (HHS). According to applicable statutory definitions, a home health agency is an agency or organization which provides home health services." Home health services in turn are defined as "health and medical services and medical supplies furnished to an individual by a home health agency, on a visiting basis, in a place of residence used as an individual's home." PBMCMC owns and operates Jupiter Hospital (JH), a 156-bed acute care facility in Jupiter, Florida. That municipality lies in Palm Beach County just south of the Palm Beach-Martin County line. A significant number of JH's patients reside in Martin County. The stipulated record suggests, but does not specifically state, that Salhaven provides home health services to JH's Medicare patients. Due to a limitation imposed on its service area, Salhaven cannot now provide home health services to Medicare patients who receive inpatient treatment at JH, but reside in Martin County. The proposed removal of this limitation is the subject of this proceeding. On December 15, 1986 PBMCMC's director of finance filed with HRS a request to expand without certificate of need (CON) review, Salhaven's service area to include Martin County, Florida. On April 15, 1987 HRS issued proposed agency action denying PBMCMC's request on the following grounds: Review of the department's files regarding Salhaven indicate Salhaven was a medicare provider in Palm Beach County prior to 1971. The records in HCFA indicate Salhaven withdrew from the medicare program after 1971 and did not reenter the program until 1984 when it sought and was approved for grandfathering into Palm Beach County. The agency approved the grandfathering of your client's home health agency in Palm Beach County based on the 1968-71 data which you produced in your July 1984 letter. However, there is no supporting information in your January 1987 letter which indicates your client served patients in Martin County during the 1968-71 period of time. The patient they served in 1975 was served during the period of time when Salhaven was not a medicare provider and was not licensed by the state. Based on this information the department cannot approve your client's request for expansion of its service region. If your client can prove they served clients in Martin County during the 1968-71 period of time when they held a provider number we will be willing to readdress this decision. The denial of the request precipitated this proceeding. Beginning in 1970, Salhaven was a home health agency providing home health services in the State of Florida. In August of that year, it was also certified by the United States Department of Health, Education and Welfare (HEW), which is HHS' predecessor, to provide Medicare services under provider number 10-7072. William Leone was Salhaven's assistant administrator from July 1968 through calendar year 1973, and its administrator from 1974 through 1983. According to his affidavit stipulated into evidence as exhibit B, Salhaven obtained a Medicare provider number from HEW in 1969 or 1970, and until Leone's retirement in 1983, Salhaven "took (no) action to withdraw... from the Medicare program, or to surrender its provider number." Leone added that had such action been taken, he would have been aware of the same. In addition, Leone filed required annual Medicare audit reports with the appropriate federal agency each year from 1970 through 1983, and utilized provider number 10-7072 on each such report. Finally, Leone did not receive a notice at any time from HEW, HHS or Blue Cross/Blue Shield advising that Salhaven's Medicare provider number had been terminated. In the affidavit of Margery Harp, stipulated into evidence as exhibit D, Harp established that during 1972, Salhaven was an active provider of home health services to Medicare recipients. However, the affidavit does not disclose in which counties (including Martin) such services were provided. The parties have stipulated, however, that Salhaven provided home health services to residents of Martin County in the months of February and November, 1975. HRS' decision to preliminarily deny PBMCMC's application is predicated upon its acquisition of a document identified as exhibit C, and which is stipulated to be a copy of a page taken from the logbook of the Health Care Financing Administration (HCFA), presumably an arm of the HHS, but whose statutory duties for and relationship to Medicare certified home health agencies is not of record. The parties have also agreed the logbook has a handwritten entry reflecting that Salhaven voluntarily withdrew from the Medicare program on November 1, 1972. Relying solely upon that information, HRS determined that Salhaven was not a Medicare participant after November 1, 1972, and therefore could not qualify for licensure. According to the admitted facts, which are drawn in part from an interview with an HCFA employee, exhibit C is a true and correct copy of a document taken from HCFA's home health agency files, and represents the manner in which records for home health agencies were maintained by HCFA in 1972. Indeed, it was the practice of HCFA to make a handwritten notation in the file when a provider was voluntarily terminated from the Medicare program. However, HCFA acknowledges that it does not know who made the handwritten entry pertaining to Salhaven, and has no correspondence or other documentation from Salhaven evidencing Salhaven's intention to withdraw from the program. The document is the only one in HCFA's possession which relates to Salhaven's participation in the Medicare program during the years 1970-1976. There is no evidence as to whether HCFA required formal or informal notice from a provider before it terminated a number, or did so on its own volition, or after receiving advice from another governmental agency. Neither is there any indication as to what office or section within HCFA had the responsibility to maintain and make entries in the logbook. There is also no evidence as to whether HCFA was the official custodian of Medicare certified home health agency records, or had the authority to issue and cancel provider numbers on its own behalf or acting as surrogate for HHS or HEW. HRS conceded its personnel have no personal knowledge, or indeed documentary evidence in its own files, to confirm that Salhaven voluntarily withdrew from the Medicare program on November 1, 1972. It also has no files pertaining to Salhaven that predate 1983. It is HRS' understanding and belief that HCFA would have terminated a provider number in 1972 if the provider had demonstrated no Medicare service activity for an extended period of time. However, this "understanding" was not corroborated by any other evidence. There is no evidence of record as to any HRS policy concerning its interpretation of the grandfather provisions of Section 400.504, Florida Statutes (1985).
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the request of Palm Beach-Martin County Medical Center for authority to expand the service area of Salhaven Home Health Agency into Martin County, Florida without certificate of need review be GRANTED. DONE AND ORDERED this 23rd day of November, 1987, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER 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 23rd day of November, 1987.
Findings Of Fact Background At all times material to this proceeding, Redi-Care was a corporation doing business as a home health care agency in Florida and was duly licensed in that capacity by the Department. Prior to May 4, 1989, Redi-Care was not certified to receive payment for services provided to Medicaid recipients under the Florida Medicaid Program. At times, however, Redi-Care did provide services to Medicaid recipients under a waiver program involving "Home and Community Based Services." This program receives funding from a separate appropriation than the one administered by the Department for the Florida Medicaid Program. Since the sale of some of the corporate assets on July 31, 1990, Ms. Ingeborg G. Mausch, Ph.D., has been authorized by the corporation to proceed with the collection of the accounts receivable that remained with the corporation. This proceeding involves Redi-Care's request for payment from the Department for medical services provided to two Medicaid eligible recipients, Richard Mow and Claire Jester. The Florida Medicaid Program is jointly funded by the federal and state governments. The Department is the state agency responsible for the administration of Medicaid funds from both funding sources. To the extent monies are appropriated, the Department is authorized to provide payment for medical services given to Medicaid eligible recipients through certified home health care agencies. Consultec was awarded the contract to replace EDS as the provider of fiscal agent services and the Medicaid agent for the Florida Medicaid Program in 1988. Pursuant to the agreement, Consultec was to become responsible for the enrollment of new providers and the processing of claims on December 15, 1988. Prior to the assumption of the fiscal agent duties, Consultec was responsible for the re-enrollment of all existing Florida Medicaid Providers into the Florida Medicaid Management System as it had been redesigned by Consultec. Current enrollees were given new provider numbers to be used on all submissions made on or after the December 15, 1988 date. Any claims submitted prior to December 15, 1988 would be processed by Electronic Data Systems Corporation (EDS) under the provider numbers previously issued by that entity. As part of the re-enrollment program, Consultec also created vendor numbers for those home health care agencies involved in the waiver program. These vendor numbers are used within the Department's Developmental Services and Aging Adult Services operations. In the past, home health care providers have not had access to these numbers. Consultec sent Vendor Information Sheets to all providers within the HRS Developmental Services and Aging Adult Services Waiver Program for "Home and Community Based Services" on October 7, 1988. Redi-Care was listed as a provider with the waiver program at the time the vendor re-enrollment occurred. Upon receipt of the Vendor Information Sheet, Redi-Care certified that the information on the sheet prepared by Consultec was correct. The document was returned to Consultec, as requested on the form, on October 19, 1988. Unbeknownst to those providers who completed the form, Consultec was planning on issuing them vendor numbers. Although each of the providers had such vendor numbers in the past, these numbers were never specifically issued to them because the Department undertook the responsibility to complete that portion of the waiver program's documentation. Application Process Originally, Redi-Care applied for enrollment as a "Medicaid Provider" in 1987. This original application was abandoned by Redi-Care when it learned that a provider had to be Medicare eligible as well. Instead, Redi-Care became a provider of "Medicaid Home and Community Based Services" in the waiver program. In July of 1988, "Medicaid Providers" were no longer required to be Medicare eligible. Based upon this policy change, Redi-Care reapplied to the Department for enrollment as a "Medicaid Provider" who provides medical services to recipients of the Florida Medicaid Program. The enrollment application, known as a "Request for Certification," was completed by Redi-Care on September 7, 1988. Assurance of Compliance with Title VI of the Civil Rights Act of 1964 was attached to the application. The Ownership and Control of Interest Statement was completed by Redi-Care, but the evidence presented reveals that it may not have been included in the application documents sent to the Department's Office of Licensure and Certification on September 7, 1988, or shortly thereafter. Pursuant to the agreement still in effect between the Department and EDS on the date of the submission of the application, EDS was the Medicaid Agent responsible for the review and processing of Redi-Care's application to become a Florida "Medicaid Provider" once it was received by EDS from the Department's Office of Licensure and Certification. Because Redi-Care was already licensed as a home health agency, the Department's Office of Licensure and Certification was not required to grant a license prior to the transfer of this enrollment application to EDS. All that was required was a certification survey from this branch of the Department and a copy of Redi-Care's active license. When the Office of Licensure and Certification went to complete the survey, the representative of the Department confused this Redi-Care entity with an entity next door known as Redi-Care, Inc. Consequently, the Redi-Care corporation seeking certification as a "Medicaid Provider" was not surveyed as it had requested via all of the proper channels. As the Office of Licensure and Certification was unaware of its mistake regarding the Redi-Care entities, this Redi-Care application package was sent on to EDS for review and processing of the application without the documentation required from the Department. After a few weeks, because Redi-Care was generally familiar with the application process from its prior experience, the Department was contacted and the follow-up package was requested. Redi-Care was sent a copy of the Medicaid Provider Agreement, which was signed and returned to the Office of Licensure and Certification on or about November 18, 1988. Within a day or two after Redi-Care mailed the Medicaid Provider Agreement, a letter was received from Consultec which referred to Redi-Care as a "Medicaid Provider." Redi-Care was thanked for re-enrolling in the program and was issued a Florida Medicaid Provider number for Home and Community Based Services. In actuality, the letter from Consultec was providing Redi-Care with the vendor number described previously in these Findings of Fact for use in the waiver program. Redi-Care was unaware that such a number was to be issued because it had not received such a number in the past, nor was it advised that one was forthcoming. When Ms. Mausch read the letter on behalf of Redi-Care, she assumed it related to the recent reapplication for Medicaid certification submitted in September 1988. The first sentence of the letter thanking Redi- Care for "re-enrollment" was interpreted as an acknowledgement of the first application for enrollment which had been abandoned, and an appreciation of the facility's current decision to assist in the provision of home health care to Medicaid recipients. Because the body of the letter appeared to be tailor made to Redi-Care's recent decision to participate as a "Medicaid Provider", Redi- Care believed its pending application for enrollment had been approved. When the letter was read and interpreted by Ms. Mausch, she failed to notice that the letter was issued four days prior to Redi-Care's submission of the Medicaid Provider Agreement, and specifically referred to "Home and Community Based Services." This mistake does not dissuade the Hearing Officer from finding Redi-Care's interpretation of the document was reasonable in light of all of the surrounding circumstances under which it was read. The references to Redi-Care as a "Medicaid Provider" in this letter issued by Consultec was ambiguous. The technical term "Medicaid Provider" was misused in a generic sense. Although the more casual use of the term might not have been misleading to most providers in the waiver program, it was very misleading to Redi-Care, who was awaiting the issuance of a "Medicaid Provider" number from the Medicaid Program. At the time the Consultec letter of November 14, 1988 was issued, EDS was the Department's Medicaid agent responsible for the review and processing of Florida's "Medicaid Provider" applications. On December 5, 1988, EDS acknowledged its receipt of Redi-Care's application to become a Florida "Medicaid Provider." The application packet was returned to Redi-Care, who was advised that additional items needed to be available with the application for processing to occur. Redi-Care was required to submit a copy of the Ownership and Control of Interest Statement. The Office of Licensure and Certification was required to complete its certification survey and submit this, along with a copy of Redi-Care's active license. The requests made by EDS were questioned by Redi-Care for the following reasons: Consultec's letter of November 11, 1988, appeared to have already approved the Medicaid enrollment, and the Office of Licensure and Certification had already been notified by Redi-Care two months earlier, and should have sent a copy of the license and survey to EDS. Instead of calling EDS, Ms. Mausch contacted Consultec, who had recently issued the "Medicaid Provider" number. During the conversation with "Deborah" of Consultec, who represented she was able to speak to Ms. Mausch's concerns, Redi-Care was advised that it need not complete the directions issued by EDS because a "Medicaid Provider" number had already been assigned by Consultec. It is unknown what exactly was said by Ms. Mausch to "Deborah" which resulted in this reply. However, the advice from "Deborah" was accepted and relied upon by Redi-Care because it was very compatible with what Redi-Care was willing to do under the known circumstances and what it reasonably believed the facts to be. Neither Redi-Care nor EDS were advised of the Department's failure to conduct the certification survey. It is also unknown whether the Department was aware of its confusion of the two Redi-Care entities at this point in time. Shortly after the re-application was returned to Redi-Care by EDS, this Department agent was relieved of its responsibility to review and process Florida "Medicaid Provider" applications. This responsibility was transferred to Consultec, the new Medicaid agent. At the time of the transfer, Consultec interpreted the return of Redi-Care's application for further attachments as a rejection of the application by EDS. Therefore, no further action was taken by Consultec on the application because it was considered to be a resolved matter. It should be noted however, that Redi-Care had not been advised that its application had been rejected, nor was any completion deadline given before rejection would occur. Redi-Care heard nothing more about the application after the discussion with "Deborah", so it continued to rely upon the representation that the new Florida "Medicaid Provider" number had been properly issued by the new Medicaid agent, and that nothing more was currently required of Redi-Care prior to its acceptance of Medicaid eligible recipients. The Acceptance and Care of Medicaid Eligible Recipients Once Redi-Care began to hold itself out as a home health agency who could accept Medicaid eligible recipients under the Medicaid Program, Richard Mow and Claire Jester were referred by their physicians and accepted as clients. There is no dispute in these proceedings about the Medicaid eligibility of either Richard Mow or Claire Jester. Further, there is no dispute regarding the quality of medical care, the dates of services, the necessity for the services and the reasonableness of the amount of the bills submitted for claims review and processing under the Medicaid Program. Richard Mow and Claire Jester were accepted as clients and services were performed based upon Redi-Care's reliance upon the representation that Redi-Care had a valid "Medicaid Provider" number that would allow it to receive payment from Medicaid appropriations for the medical care of these two clients. The Department was aware of the acceptance of these two Medicaid eligible recipients as clients by Redi-Care. The Department was also aware that they were being provided medical services for which Redi-Care expected to be reimbursed by the Medicaid Program. The two clients also relied upon this method of payment for the medical services provided by Redi-Care as third-party beneficiaries to the purported agreement between Redi-Care and the Medicaid Program. The amount of the claim submitted for services provided to Richard Mow from February 8, 1989 through April 16, 1989 was $7,411.45. The amount of the claim submitted for services provided to Claire Jester from February 12, 1989 through April 30, 1989 was $753.83. The Submission of Claims and Claims Denial Redi-Care first submitted billings and notes for the claims involving Richard Mow and Claire Jester to Consultec on March 29, 1989. On April 11, 1989, Redi-Care contacted Elizabeth Campbell, a Human Services Program Specialist with the HRS Medicaid Program Office in Fort Myers, Florida. At the time Ms. Campbell was contacted, her job duties included claims resolution for providers in the home health and nursing home areas. The purpose of the phone call from Redi-Care was to ask Ms. Campbell to find out why it had not received word on its claim submission to Consultec for Richard Mow and Claire Jester. After Ms. Campbell researched the issue, she discovered that Redi-Care was not listed as a "Medicaid Provider" on the rolls maintained by Consultec. Redi-Care was ineligible for payment through Medicaid. Payment could be received only as a provider of "Home and Community Based Services" under the waiver program. When Redi-Care was advised that it did not have a "Medicaid Provider" number on April 11, 1989, the Department was told about the information given to Ms. Mausch by Consultec's letter and her follow-up conversation with "Deborah". Ms. Campbell, as a representative of the Department, assured Redi-Care that the matter would be pursued further. In the meantime, through its employees, the Department allowed Redi-Care to continue to rely on the representation that it would be paid at the Medicaid rates for the continuing care provided to Richard Mow and Claire Jester. On April 12, 1989, Ms. Campbell recorded in her field notes that she did not make any assurances to Redi-Care that it would be paid for providing services for the two clients. However, there is no evidence to show that she affirmatively advised Redi-Care that they might not get paid for past or continuing services. Redi-Care was allowed to continue to care for the clients under the the assumption that Medicaid would provide payment. On April 18, 1989, it was clear to Department employees involved in this factual scenario that the Office of Licensure and Certification had confused this Redi-Care entity with Redi-Care, Inc. when the survey and certification was scheduled to occur in November 1988. This mistake had never been corrected. On April 26, 1989, Consultec completed its review of the claims submitted by Redi-Care and denied the claims because Redi-Care did not have a "Medicaid Provider" number. Attempts to Cure Certification Issue The Office of Licensure and Certification completed its survey on May 4, 1989. Redi-Care's enrollment application was complete, and contained all of the required information on this date. Although no deficiencies were noted during the survey, the Department did not send a copy of the letter stating Redi-Care met its requirements until June 27, 1989. On that date, the letter was sent to Redi-Care, who was required to forward it to Consultec, along with the application Redi-Care had previously submitted with the attachments requested in December 1988 by EDS. Once Redi-Care received the letter in early July 1989, the information was immediately forwarded to Consultec. Consultec reviewed the application and issued Redi-Care a "Medicaid Provider" number on August 6, 1989. When Redi-Care received its "Medicaid Provider" number, it was advised by Consultec that it could use this number to submit billings to the Medicaid Program for eligible services provided since September 1988. Apparently, Consultect relied on the date EDS acknowledged receipt of the application and related the eligibility date to the 90 day period prior to the application receipt. On September 19, 1989, the Department issued a letter through the Program Administrator, Medicaid Program Office, advising Redi-Care that the Medicaid billings for Richard Mow and Claire Jester would not be paid by the Medicaid Program, even though these services were provided after the effective date of eligibility given to Redi-Care by Consultec in its letter of August 6, 1989. The Department's letter advising Redi-Care of the Medicaid Program's decision to deny payment for the services provided to the two Medicaid eligible recipients also told Redi-Care that its "Medicaid Provider" number could be used only for services rendered on or after May 4, 1989.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is recommended: Redi-Care's application for enrollment as a "Medicaid Provider" be deemed complete on May 4, 1989. Redi-Care's eligibility period to submit claims as a "Medicaid Provider" should be listed as February 4, 1989, based upon the eligibility period set forth in the "Medicaid Provider Handbook, Home Health Care Services" in effect on the date the application was completed. The Department waive time limits for claims received beyond the usual 12 month period, as allowed in Rule 10C-7.030(6), Florida Administrative Code, based upon the unusual circumstances of this case because the circumstances pose an undue hardship on the provider or recipients. That the claims for services provided to Richard Mow and Claire Jester be re-submitted to Consultec for claims processing once the 12-month deadline is waived by the Department. That the amount of the reimbursement allowed to Redi-Care should be provided at the rates in effect at the time the services were rendered. RECOMMENDED this 11th day of June, 1991, in Tallahassee, Leon County, Florida. VERONICA E. DONNELLY 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 June, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 89-6923 Redi-Care's proposed findings of fact are addressed as follows: Accepted. See HO number 4. Accepted. See HO number 5. Accepted. Accepted. Accepted. Accepted. See HO number 15. Accepted. Accepted. Accepted. Accepted. Accepted. See HO number 40. Accepted. Accepted. See HO number 42. Accepted. See HO number 14 - number 27. Accepted. Accepted. Accepted. Accepted. Accepted. See HO number 45. Accepted. See HO number 29. Accepted. See HO number 38. Accepted. See HO number 35. Rejected. Contrary to fact. See HO number 5 - number 7 and number 16. Rejected. Contrary to fact and Redi-Care Exh. number 9. Rejected. See HO number 35 - number 38. Accepted. See HO number 39. Accepted. Rejected. Contrary to fact. Accepted. Rejected. Improper conclusion of law. Accepted. See HO number 32. Accepted. See HO number 33. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. See HO number 8. Accepted. Accepted. See HO number 8. Accepted. See HO number 9. Reject due to use of technical term "Medicaid Provider." See HO number 18. Otherwise, accepted. See HO number 15. Accepted. Accepted. See HO number 28. Accepted. See HO number 30 - number 31. Accepted. See HO number 34. Accepted. Accepted. Accepted. Accepted. Accepted. See HO number 5. Accepted. Accepted. Accepted. Accepted. See HO number 2. Accepted. See HO number 2. The Department's proposed findings of fact are addressed as follows: Accepted. See HO number 2. Accepted. See HO number 3. Rejected. Contrary to fact. See HO number 5. Accepted. See HO number 1. Accepted. See HO number 1. Accepted. See HO number 5, number 15 and number 16. Accepted. See HO number 6 and number 7. Accepted. See HO number 7. Accepted. Accepted. See HO number 15 and number 16. Accepted. See HO number 45. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Accepted. Rejected. Irrelevant. Rejected. Conclusion of Law, not fact. Accepted. Accepted. Rejected. Contrary to fact. Accepted. See HO number 5. Accepted. Accepted. Accepted. Accepted. Accepted. See HO number 9. Accepted. See HO number 40. Accepted. Accepted. See HO number 43 - number 45. Rejected. Improper conclusion. Accepted. Accepted. See HO number 20. Accepted. See HO number 22 - number 24. Rejected. Contrary to fact. See HO number 27. Rejected. Irrelevant to this proceeding. Consultec's proposed findings of fact are addressed as follows: Accepted. See HO number 1 - number 2. Accepted. See HO number 3. Accepted. See HO number 3. Generally accepted, except for the dates of enrollment and claims processing. See HO number 4 and number 5. Accepted. See HO number 5 - number 7. Rejected. Conclusionary and contrary to fact. See HO number 15 - number 17. Accepted. See HO number 15 - number 17. Accepted. Rejected. Contrary to fact. See HO number 20. Accepted, except for the conclusion that this was a rejection letter. See HO number 20 and number 26. Reject the classification as rejection letter. Improper conclusion. See HO number 20. The rest of the paragraph is factually correct. See HO number 22 - number 24. Rejected. Irrelevant. Rejected. Improper definition of hearsay. Accepted. Accepted. See HO number 45. Accepted. See HO number 40. Accepted. See HO number 40. Rejected. Contrary to fact. See HO number 16, number 17 and number 27. COPIES FURNISHED: Karel Baarslag, Esquire Senior Attorney Department of Health and Rehabilitative Services 1317 Winewood Boulevard Building Six, Room 233 Tallahassee, Florida 32399-0700 Barry Roth, Esquire COHEN AND ROTH, P.A. 1375 Jackson Street, Number 201 Post Office Drawer 2650 Fort Myers, Florida 33902-2650 Ken Syler CONSULTEC, INC. 2002 A1 Old St. Augustine Road Post Office Box 5497 Tallahassee, Florida 32314-5497 R. S. Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Linda K. Harris, Esquire General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Conclusions Having reviewed the administrative complaint dated March 5, 2009, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration ("Agency") has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: 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. Respondent shall pay an administrative fine in the amount of $5,000.00. The administrative fine is due and payable within thirty (30) days of the date of rendition of this Order. Filed June 30, 2009 2:08 PM Division of Administrative Hearings. 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: Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. Respondent's petition for formal administrative proceedings is hereby dismissed. Each party shall bear its own costs and attorney's fees. The above-styled case is hereby closed. DONE and ORDERED this &day of- ------= - --, 2rx:;[j, in Tallahassee, Leon County, Florida. , Secretary ealth Care Administration A PARTY WHO IS 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: Jeffrey G. Schneider, Esq. Attorney for Respondent Hogan & Harston LLP 875 Third Avenue . New York, NY 10022 (U. S. Mail) Finance & Accounting Agency for Health Care Administration Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 NW 52nd Terrace, Suite 103 Miami, Florida 33166 (Interoffice Mail) Hon. John C. Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Home Care Unit Agency for Health Care Administration 2727 Mahan Drive, MS #34 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the y of =: Je-,1'\Q_..- , 20&. Richard Shoop, Cler Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA
Conclusions any 212 Poe ap, AS 1g DOAH No. 12-2633 AHCA No. 2012003965 RENDITION NO.: AHCA-12- {tF 27S Ole DOAH No. 12-2865 AHCA No. 2012008077 License No. 11870 File No. 11967907 Provider Type: Assisted Living Facility DOAH No. 12-2866 AHCA No. 2012003189 THIS CAUSE came on for consideration before the Agency for Health Care Administration (“the Agency”), which finds and concludes as follows: 1 The applicant’s fictitious names on the settlement agreement are reversed. 1 Filed December 7, 2012 4:54 PM Division of Administrative Hearings 1. The Agency has jurisdiction over the above-named Provider pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Notices of Intent to Deny and Election of Rights forms to the Provider. (Composite Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) 4. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 5. The Provider’s renewal application for Cooper’s Retirement Home and initial application for Cooper’s Residential Home are withdrawn without prejudice to the Provider reapplying for such licensure in the future. The corresponding Notices of Intent to Deny these applications are moot and are thus withdrawn. 6. In accordance with Florida law, the expiration date of the existing license for Cooper’s Retirement Home is extended 30 days for the sole purpose of allowing the safe and orderly discharge of clients. At the conclusion of 30 days or upon the discontinuance of operations, whichever is first in time, the Petitioner shall immediately return the license certificate for the license which is the subject of this action to the appropriate licensure unit in Tallahassee, Florida. 7. The Provider shall pay the Agency $2,500.00. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the “Agency for Health Care Administration” and containing the AHCA ten-digit case number should be sent to: Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 8. Any requests for an administrative hearing are withdrawn. The parties shall bear their own costs and attorney’s fees. This matter is closed. ORDERED in Tallahassee, Florida, on this (“4 day of Qeaertlee.. 52012.
Other Judicial Opinions A party that is adversely affected by this Final Order is entitled to seek 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy ofthis Final we was served on the below- named persons/entities by the method designated on this 6 day of , 2012. Richard Shoop, Agency Cler Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone (850) 412-3630 Jan Mills Shaddrick Haston, Unit Manager Facilities Intake Unit Assisted Living Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Finance and Accounting Theresa DeCanio, Field Office Manager Revenue Management Unit Area 7 Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Katrina Derico-Harris Medicaid Accounts Receivable Agency for Health Care Administration (Electronic Mail) Edwin D. Selby, Senior Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Shawn McCauley Medicaid Contract Management Agency for Health Care Administration Harvey M. Alper, Esquire Post Office Box 162967 Altamonte Springs, Florida 32716-2967 (U.S. Mail) | Electronic Mail) Lynne A. Quimby-Pennock Administrative Law Judge Division of Administrative Hearings (Electronic Mail) NOTICE OF FLORIDA LAW 408.804 License required; display.-- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. 408.812 Unlicensed activity.-- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.
