The Issue The issue in this matter concerns the amount of monetary sanctions that the Agency for Health Care Administration may impose on Respondent pursuant to section 409.913, Florida Statutes, and Florida Administrative Code Rule 59G-9.070(7)(e) based on the overpayment of Medicaid reimbursements made to Respondent.
Findings Of Fact AHCA is designated as the single state agency authorized to make payments for medical assistance and related services under Title XIX of the Social Security Act, otherwise known as the Medicaid program. See § 409.902(1), Fla. Stat. AHCA is responsible for administering and overseeing the Medicaid program in the State of Florida. See § 409.913, Fla. Stat. AHCA's Bureau of Medicaid Program Integrity (“MPI”) is the unit within AHCA that oversees the activities of Florida Medicaid providers and recipients. MPI ensures that providers abide by Medicaid laws, policies, and rules. MPI is responsible for conducting audits, investigations, and reviews to determine possible fraud, abuse, overpayment, or neglect in the Medicaid program. See §409.913, Fla. Stat. At all times relevant to this proceeding, Respondent was an enrolled Medicaid provider authorized to receive reimbursement for covered services rendered to Medicaid recipients. Respondent had a valid Medicaid provider agreement with AHCA, Medicaid Provider No. 0742236-00. The Medicaid provider agreement is a voluntary contract between AHCA and the provider. As an enrolled Medicaid provider, Respondent was subject to the duly-enacted federal and state statutes, regulations, rules, policy guidelines, and Medicaid handbooks incorporated by reference into rule, which were in effect during the audit period. Pursuant to its statutory authority to oversee the integrity of the Medicaid program, MPI conducted an audit of Respondent's paid claims for Medicaid reimbursement for the period from April 1, 2011, through October 31, 2013. The audit’s purpose was to verify that claims AHCA paid to Respondent under the Medicaid program did not exceed the amount authorized by Medicaid laws, policies, and applicable rules. As a result of the audit, AHCA determined that Respondent was overpaid in the amount of $177,717.69 for services that, in whole or in part, were not covered under the Medicaid program. AHCA also sought to impose sanctions upon Respondent consisting of an administrative fine of $34,192.30,2/ as well as investigative, legal, and expert witness costs of $1,127.66. Respondent is a dentist specializing in pediatric dentistry. He has practiced for over 43 years. He maintains offices in both Clearwater and Jacksonville, Florida. Respondent’s dental practice serves almost exclusively developmentally disabled children. Many of his patients suffer from severe behavioral, emotional, mental, physical, or social handicaps or other medical issues. Respondent’s practice is primarily based on referrals of special needs patients who other pediatric and general dentists send to him for treatment. Approximately, 95 percent of Respondent’s patients are Medicaid recipients. At the final hearing, AHCA presented the testimony of Robi Olmstead, an AHCA administrator with MPI. Ms. Olmstead's responsibilities include overseeing MPI investigations and supervising AHCA staff’s performance of Medicaid audits. With over 10 years of experience in her position, Ms. Olmstead is very familiar with and knowledgeable about how MPI conducts Medicaid audits. Specifically related to this matter, Ms. Olmstead, in her official capacity with AHCA, signed the FAR that MPI presented to Respondent on April 8, 2015. Ms. Olmstead described MPI’s Medicaid audit of Respondent’s Medicaid claims.3/ Using AHCA's data support system, MPI investigators accessed the complete universe of Respondent’s Medicaid claims. MPI selected the period from April 1, 2011, through October 31, 2013, as the audit period. MPI calculated the amount of overpayment based on its review of a random sample of 35 recipients for whom Respondent submitted 507 claims during the audit period. AHCA then contacted Respondent and requested that he submit documents to substantiate his Medicaid claims for the 35 recipients. In response to AHCA’s request for documents, Respondent provided his records of service and billing for each of the 507 claims for the 35 recipients. AHCA, upon receiving Respondent’s records, forwarded them for a peer review. The peer reviewer evaluated the records and prepared worksheets reflecting a determination regarding the nature of the dental services rendered for each claim, and whether such claim was eligible for payment under the Medicaid program. Based on the peer reviewer’s determination, MPI calculated that Respondent had been overpaid for all claims he presented within the audit period by a total of $177,717.69. After determining that Respondent had been overpaid, AHCA prepared and sent to Respondent a Preliminary Audit Report (“PAR”), dated February 12, 2015. The PAR notified Respondent that the audit revealed that he had been overpaid by $177,717.69. On April 8, 2015, AHCA issued the FAR. The FAR served as AHCA’s final determination that Medicaid had overpaid Respondent. The FAR set forth the following bases for AHCA’s determination that Respondent was overpaid: Documentation Supported a Lower Level of Service (“LL”): The peer review of Respondent’s records revealed that the documentation Respondent submitted for payment did not support level of service for some claims. These claims may involve an established patient that Respondent coded as a new patient (which is billed at a higher level). AHCA believed that Respondent should have used a different code for the service he provided. AHCA considered the Medicaid payments made to Respondent for these services in excess of the appropriate amount an overpayment.4/ No Documentation (“No Doc”): Respondent’s records revealed that some medical services for which Respondent billed and received payment were incomplete or lacked sufficient documentation. AHCA considered the Medicaid payments for these services an overpayment.5/ Not Medically Necessary (“NMN”): The peer review of Respondent’s claims revealed that the documentation did not support the medical necessity of some of the claims Respondent presented for payment. (Respondent explained that this category of claims related to occlusal x-rays he obtained from dental patients for whom he also had taken panorex x-rays. The peer review considered these charges duplicative.) Therefore, AHCA considered the Medicaid payments made to Respondent for these claims an overpayment.6/ Erroneous Coding (“EC”): The peer review of Respondent’s claims revealed that some services rendered were erroneously coded on the submitted claim. These services documented one activity, but another billing code was identified. Consequently, AHCA considered Medicaid payments made to Respondent for claims in excess of the appropriate service an overpayment.7/ Behavioral Management (“BM”) Services Not Reimbursable: The peer review of Respondent’s claims revealed that Respondent did not adequately explain his claims for BM services. Respondent should not have requested payment for BM without explaining why BM was used or the specific type of BM techniques utilized for treatment. Furthermore, the peer review determined that Respondent should not have included BM in his claim if he also billed for either sedation or analgesia on the same date of service. AHCA considered Medicaid payments made to Respondent for these BM claims an overpayment.8/ The FAR also notified Respondent that AHCA had calculated and was seeking to assess a fine of $35,543.54 (since lowered to $34,192.30). Ms. Olmstead explained that, in accordance with section 409.913(15), (16), and (17) and rule 59G- 9.070, AHCA must apply sanctions for violations of federal and state laws, including Medicaid policy. AHCA determined to sanction Respondent in the form of an administrative fine. After determining that Respondent had been overpaid for Medicaid claims, AHCA prepared a Documentation Worksheet for Imposing Administrative Sanctions (“Worksheet”). The Worksheet was signed on April 7, 2015, by an AHCA investigator. Ms. Olmstead also signed the Worksheet after she reviewed and approved the form. The Worksheet specified how AHCA calculated the fine it sought to impose on Respondent for the Medicaid claims violations listed above. As noted on the Worksheet, AHCA found a total of 58 claims violated Medicaid laws, policies, and rules. The specific number of claims in violation were: lower level of service 38; no documentation, 9; not medically necessary, 8; error in coding, 2; and behavior management/illegal documentation, 1. The Worksheet also contained a section that read: Confirm that you have considered the following via checking the box: I have considered the serious & extent of the violation. I have considered whether there is evidence that the violation is continuing after written notice. I have considered whether the violation impacted the quality of medical care provided to Medicaid recipients. I have considered whether the licensing agency in any state in which the provider operates or has operated has taken any action against the provider. If the sanction to be imposed is suspension or termination, I have considered whether the sanction will impact access by recipients to Medicaid services. The AHCA investigator placed a checkmark by each consideration. AHCA did not use any additional forms or methods to document its consideration of these factors. AHCA did not provide the Worksheet to Respondent with the FAR. The Worksheet is an internal AHCA document the investigator and administrator use to calculate the amount of a fine. However, AHCA did include in the FAR the final monetary sanction which AHCA calculated on the Worksheet ($35,543.54). Ms. Olmstead stated that AHCA considered Respondent’s failure to comply with Medicaid laws a “first offense.” Pursuant to rule 59G-9.070(7)(e), AHCA shall impose a $1,000 fine per claim found to be in violation for a first offense. Accordingly, based on the 58 claims reviewed for the audit, AHCA calculated a fine of $58,000.00. Thereafter, rule 59G-9.070(4)(a) instructs AHCA to limit the monetary sanction for a “first offense” violation of Medicaid laws under rule 59G-9.070(7)(e) to twenty percent of the amount of the overpayment. Thus, AHCA reduced the amount of the fine it seeks to impose on Respondent to $34,192.30. Finally, Ms. Olmstead testified that the FAR cited to several documents that AHCA distributes to guide and inform providers of the types of services that the Medicaid program covers and how to correctly bill Medicaid for these services. The documents applicable to this matter are: the 2007 Florida Medicaid Dental Services Coverages and Limitations Handbook; the 2008 Florida Medicaid Provider General Handbook; the 2011 Florida Medicaid Dental Services Coverages and Limitations Handbook; and the 2012 Florida Medicaid Provider General Handbook. Respondent testified on his own behalf. Respondent testified that this Medicaid audit was the first he has experienced. Prior to this matter, he has never been fined or sanctioned for any violations of the Medicaid program. Respondent also emphasized that this Medicaid audit did not show that he ever rendered sub-quality dental care to any of his patients. Respondent acknowledged that he currently receives the Medicaid Handbooks electronically. Respondent conceded that he is bound to adhere to the Medicaid guidelines in the Handbooks. Respondent offered the following explanations for the claims he submitted which resulted in the overpayments: Not Medically Necessary: Respondent understood that AHCA determined that his claims for occlusal x-rays were considered duplicative. Respondent explained that the occlusal x-rays reveal tooth decay and disease that panorex x-rays do not. Furthermore, Respondent’s use of the occlusal x-rays did not result in any harm to his patients. On the contrary, Respondent expressed that these x-rays only enhanced the services and treatment he provided to his patients. Behavioral Management (“BM”) Services: The BM fee compensates the provider for the effort and time it takes to prepare a patient for dental treatment or control the patient during treatment. In many cases, if Respondent cannot employ BM techniques, he cannot render effective dental treatment. Respondent charges approximately $35 for BM services. Insufficient Records: Respondent stated that the medical notes and records that his office maintains meet or exceed Florida standards. However, certain of his records apparently did not comply with Medicaid program requirements. Respondent further asserted that AHCA never alleged that he sought payment for services he never delivered or were not completed. Sabrina Blake is the office manager for Respondent’s dental practice. As part of her responsibilities, she handles billing practice inquiries. Regarding AHCA’s claim of insufficient records to support the BM charges, Ms. Blake explained that Respondent marked “BM” on the patients’ records to indicate that a behavior management technique was used. The error was that Respondent did not write out exactly what behavior management technique was used during the treatment. Medicaid rules required additional information or documentation. Therefore, while Respondent’s practice did not provide the requisite notation to support a Medicaid payment for BM charges, Respondent did actually provide the service claimed. Respondent stated that AHCA never provided him the opportunity to correct any alleged violations or billing errors. Respondent claims that none of the disallowed charges or medical services were submitted to intentionally obtain an unauthorized payment from the Medicaid program. AHCA did not produce evidence to contradict Respondent’s assertion. Prior to the final hearing, the parties entered into an agreement wherein Respondent agreed to repay to AHCA the full amount of the overpayment Respondent received from the Medicaid program.9/ Based on the overpayment, AHCA seeks to impose on Respondent an administrative fine of $34,192.30. Accordingly, the primary issue for the undersigned to consider is whether AHCA is authorized under the applicable law to impose on Respondent an administrative sanction in the form of a fine as a result of his violation of Medicaid laws, rules, or policy. Based on the evidence presented at the final hearing, AHCA proved by clear and convincing evidence that Respondent failed to comply with provisions of the Medicaid laws.10/ As detailed below, section 409.913 and rule 59G-9.070 authorize AHCA to impose a fine on Respondent in the amount of $34,192.30 based on his violations of the Medicaid program. Consequently, a fine of $34,192.30 should be assessed against Respondent.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that AHCA issue a final order imposing an administrative fine of $34,192.30 for Respondent’s first offense of violating provisions of Medicaid provider publications adopted by AHCA rules, Florida or federal laws or regulations governing the Medicaid program, or the provider’s Medicaid agreement with AHCA. DONE AND ENTERED this 10th day of March, 2016, in Tallahassee, Leon County, Florida. S J. BRUCE CULPEPPER 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 10th day of March, 2016.
The Issue The issue in this case is whether a petition filed by Petitioner challenging Medicaid audit adjustments suggested by Respondent should be accepted pursuant to the doctrine of equitable tolling.
Findings Of Fact The Parties. Petitioner, Avante, Inc. (hereinafter referred to as "Avante"), is the lessee and manager/operator of five skilled nursing facilities (hereinafter collectively referred to as the "Nursing Facilities") in Florida: Avante at Inverness. A 104-bed nursing home located at 304 South Citrus Avenue, Inverness, Florida. Medicaid Provider No. 203220; Avante Villa at Jacksonville Beach. A 165-bed nursing home located at 1504 Seabreeze Avenue, Jacksonville, Florida. Medicaid Provider No. 200913; Avante at Boca Raton. A 120-bed nursing home located at 1130 Northwest Fifteenth Street, Boca Raton, Florida. Medicaid Provider No. 210676; Avante at Lake Worth. A 162-bed nursing home located at 2502 North A Street, Lake Worth, Florida. Medicaid Provider No. 203238; and Avante at Leesburg. A 116-bed nursing home located at 2000 Edgewood Avenue, Leesburg, Florida. Medicaid Provider No. 203122. Each of the Nursing Facilities is licensed in Florida and certified to participate in the Medicaid program. Respondent, the Agency for Health Care Administration (hereinafter referred to as the "Agency"), is, among other things, the Medicaid agent for the State of Florida and is charged with responsibility for oversight of nursing homes in Florida. Chapters 400 and 409, Florida Statutes. The Medicaid Program. As part of the duties of participating in the Medicaid program in Florida, providers such as the Nursing Facilities are required to submit cost reports to the Agency annually. Annual cost reports submitted by providers are reviewed by the Agency or its contractors by either a desk review or a more thorough audit. If an audit is performed, the Agency's contract auditors meet with the provider at the location of the provider to verify the information contained in the cost report. Following the on site portion of the audit, Schedules of Proposed Audit Adjustments (hereinafter referred to as "SOPAAs") are prepared and provided to the provider. The SOPAAs are reviewed and discussed during an "exit" conference, unless waived. For 60 days following the exit conference, additional information may be submitted in response to the SOPAAs. The SOPAAs may be revised as a result of any additional information. The SOPAAs are next sent to the Agency for review and finalization. Once finalized, a notice letter is sent to the provider with the final audit report attached. The notice letter informs the provider of the availability of a hearing to contest the audit findings and the time within which the hearing must be requested. Providers are informed that they have 21 days from receipt of the notice letter in which to request a hearing. If a hearing is not requested by a provider, the Agency calculates a revised prospective per diem rate for the provider based on average cost. If the provider is in its first year of operation, a retroactive rate is also established. A rate change letter is then sent to the provider by the Agency. The rate change letter sets out the old rate, the new rate, the applicable time frame, and the reason for any rate adjustment. Avante's Facilities, Personnel, and Mail Procedures. Avante's home office is located at 4000 Hollywood Boulevard, Hollywood, Florida (hereinafter referred to as the "Home Office"). Approximately 20 employees work at the Home Office, including the Vice President of Operations and the Vice President of Financing. Avante also maintains a satellite office a few blocks from its Home Office at 3709 Polk Street, Hollywood, Florida (hereinafter referred to as the "Satellite Office"). At all times relevant to this matter the Satellite Office was occupied by Avante's reimbursement staff. Avante personnel responsible for complying with Medicaid program requirements were located at the Home and Satellite Offices. At all times relevant to this matter, Mr. Darren Caruso served as Avante's Vice President for Reimbursement. Mr. Caruso's office, Suite 540, was located at the Home Office. At all times relevant to this matter, Ms. Linda Beloat served as the Corporate Director of Reimbursement for Avante. No formal job description for the Corporate Director of Reimbursement for Avante exists now or at any time relevant to this matter. Ms. Beloat's office was at the Satellite Office. A small clerical staff also works at the Satellite Office. Ms. Beloat was responsible for overseeing the staff at the Satellite Office. Ms. Beloat and her staff were responsible for gathering and storing reimbursement information from the Nursing Facilities and nine other facilities located outside of Florida. Ms. Beloat reported directly to Mr. Caruso and was supposed to keep Mr. Caruso up to date on Medicaid audits, which were performed at the Satellite Office. Ms. Beloat and Mr. Caruso had frequent contact, usually by telephone. Ms. Beloat was designated by Mr. Caruso as the "contact person" on behalf of Avante for purposes of Medicaid audits. At all times relevant to this matter, Avante established a procedure for handling incoming mail. Mail, including Medicaid related mail, was delivered to a mailbox in the garage of the Home Office. An Avante employee located at the Satellite Office used a mailbox key maintained by Ms. Beloat to pick up the mail each day. Mail was taken to the Satellite Office and provided to Ms. Beloat. Ms. Beloat reviewed the mail and determined whether it needed to be filed in the Satellite Office or returned to the Home Office for distribution. Information from the Nursing Facilities concerning the Medicaid program was provided by facsimile directly to the Satellite Office. The Agency's Audit of Avante for Fiscal Year 1994. Cost reports were submitted by Avante for each of the Nursing Facilities for the fiscal year ending May 31, 1994 (hereinafter referred to as the "1994 Cost Reports"). The 1994 Cost Reports were audited by the Agency's contract auditors, KPMG Peat Marwick. During late 1995, a representative of KPMG Peat Marwick, Ms. Catherine Conroy, spent a day at the Nursing Facilities and two to three days at the Satellite Office auditing the 1994 Cost Reports. Mr. Caruso was aware of the audit. Mr. Caruso met with Ms. Conroy when she arrived at Avante to commence the audit. Ms. Beloat was designated by Mr. Caruso as the "contact person" regarding each of the cost reports submitted for the 1994 fiscal year. This designation included no limitation as to Ms. Beloat's authority or lack thereof. Nor did anyone at Avante inform the Agency or its auditors that Ms. Beloat was not authorized to represent Avante with regard to the 1994 audit. Ms. Conroy sent letters dated January 15, April 18, and May 20, 1996, to Ms. Beloat requesting additional documentation. The information was never provided. On or about December 15, 1995, SOPAAs were sent to Avante setting forth proposed adjustments to the allowable costs for each of the Nursing Facilities. The proposed adjustments decreased allowable costs for the Nursing Facilities in the following net amounts: Avante at Inverness: $161,420.00; Avante Villa at Jacksonville: $102,539.00; Avante at Lake Worth: $134,082.00; Avante at Boca Raton: $249,804.00; and Avante at Leesburg: $169,544.00 The total proposed decrease amounted to $817,389.00. An exit conference was originally scheduled for December 1995. The conference was rescheduled for January 15, 1996, at Ms. Beloat's request because she had not had sufficient time to review the SOPAAs. On the day of the rescheduled exit conference Ms. Beloat informed Ms. Conroy that she was still not prepared for the conference. Ms. Conroy told Ms. Beloat that she had sufficient time to prepare and, therefore, she was willing to conduct the conference right then or not at all. Ms. Beloat declined to go over the SOPAAs. Ms. Conroy told Ms. Beloat that their conversation constituted the exit conference and that she had 60 days to provide additional information. Ms. Beloat did not indicate whether she needed authorization from anyone at Avante to waive an exit conference. Ms. Conroy requested that Ms. Beloat sign exit conference waiver forms by letter dated January 15, 1996. Exit waiver forms were sent with the letter. The exit conference wavier forms were not returned to Ms. Conroy. Another set of exit conference waiver forms was sent to Ms. Beloat by letter dated April 18, 1996. The forms were not returned to Ms. Conroy. Finally, a third set of exit conference waiver forms was sent to Ms. Beloat by letter dated May 20, 1996. Ms. Beloat signed the third set of exit conference waiver forms on May 21, 1996, and returned them to Ms. Conroy. Avante had not given Ms. Beloat permission to waive exit conferences without Mr. Caruso's approval. Ms. Beloat did not get approval from Mr. Caruso to waive the exit conference for the May 1994 audit. Ms. Beloat's failure to respond to request for documentation which she was responsible for maintaining resulted in substantial costs allowance denials for the Nursing Facilities. Ms. Beloat was aware of these consequences. The failure to obtain the documentation timely gave Ms. Beloat a reason to not keep Mr. Caruso completely informed of the audit. The evidence proved that neither Mr. Caruso nor anyone else at Avante had any motivation to waive an exit conference or otherwise fail to continue to work with the Agency's auditors. Mr. Caruso was, however, aware that the audit was ongoing and inquired of Ms. Beloat about when an exit conference would be held. Ms. Beloat told him that the exit conference had been delayed. Even though Mr. Caruso was aware of the ongoing audit and that there were time limitations on contesting audit findings, he did not continue to ask Ms. Beloat about the audit conference or become suspicious when he was not informed of when the exit conference would take place. It was not unreasonable to assume, however, that the audit was ongoing during the time between when the audit began in late 1995 and when Mr. Caruso became aware of the final audit results in late 1997. The Agency's Proposed Decision: the Notice Letters. On or about November 5, 1996, the Department mailed Notice Letters to each of the five Nursing Facilities via certified mail. The Notice Letters constituted the Agency's proposed final audit adjustments, which were higher than those suggested by the SOPAAs. The Notice Letters also informed the Nursing Facilities and Avante of the time within which the Agency's proposed decision could be challenged. The Notice Letters were received at the Nursing Facilities on November 7 and 8, 1996. The Nursing Facilities of Avante, therefore, had actual notice of the results of the audit and the time within which the audit findings had to be contested. The Nursing Facility administrators, however, did not have the authority to act on the Notice Letters and followed Avante procedures by not taking any further action on the Notice Letters. The Department also mailed a copy of the Notice Letters to Avante's post office box located on the first floor of the Home Office. The copy of the Notice Letters was mailed with a label addressed to Mr. Caruso at the Home Office address and Mr. Caruso's suite number. Mr. Caruso did not actually receive the copy of the Notice Letters addressed to him and was not aware of them. The copy of the Notice Letters was actually received at Avante. Someone, likely Ms. Beloat, actually received the Notice Letters. Therefore, Avante was provided actual notice of the results of the audit and the time within which the audit findings had to be contested. To the extent that Mr. Caruso and others at Avante responsible for making the ultimate decision whether to contest audit findings did not receive actual notice, it was due to the designation by Mr. Caruso of Ms. Beloat as the contact person for the audit and the failure of Avante to establish adequate procedures to prevent a single employee from preventing responsible individuals at Avante from being aware of audit results. The Agency's proposed cost allowance reductions for the Nursing Facilities were not contested in a timely manner by Avante. As a consequence, a significant amount of costs reported by the Nursing Facilities for the fiscal year ending May 1994 were denied by the Agency. The Rate Change Letters. The actual impact of the denied costs did not take effect until the rate of Medicaid Reimbursement Per Diem paid to the Nursing Facilities was adjusted. Avante was informed of the rate change in August and September 1997 when Avante received Medicaid Reimbursement Per Diem Rate Letters from the Agency indicating the per diem rate for the Nursing Facilities was being reduced. The Rate Letters informed Avante that the reduction in rates was due to the audit adjustments for the fiscal year ending 1994. A copy of the final audit adjustments was attached to the Rate Letters for each facility. Avante's Petition. Mr. Caruso attempted to find out why the audit had become final without his knowledge. On November 21, 1997, approximately two years after the audit began, more than a year after the Notice Letters were provided to Avante, and two months after receiving the Rate Letters, Avante filed a Petition with the Agency seeking to challenge the final audit findings proposed by the Agency in the Notice Letters. In light of the fact that Mr. Caruso was not aware of the final audit findings and, therefore, why the rates for the Nursing Facilities were being reduced, his actions in investigating the Rate Letters before filing the Petition were reasonable. Ms. Beloat's Termination. Ms. Beloat was terminated by Mr. Caruso in March of 1997. She was terminated because of her failure to properly handle another Medicaid audit of Avante. No investigation was conducted by Avante to determine whether Ms. Beloat had failed to properly handle other Medicaid audits, including the audit at issue in this case. I. The Agency's Dismissal of the Petition. Failure to adhere to deadlines concerning Medicaid audits negatively impacts the Agency's ability to perform its responsibility. The Agency dismissed the Petition because it had not been timely filed by Final Order entered April 1, 1998. By Per Curiam opinion entered December 31, 1998, the First District Court of Appeal remanded the matter to the Division of Administrative Hearings to determine whether equitable tolling applies.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered by the Agency for Health Care Administration finding that the doctrine of excusable neglect applies and accepting the Petition for Formal Hearing filed by Avante, Inc. DONE AND ENTERED this 23rd day of December, 1999, in Tallahassee, Leon County, Florida. LARRY J. SARTIN 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 23rd day of December, 1999. COPIES FURNISHED: Samuel J. Morley, Esquire Susan L. Turner, Esquire Holland & Knight, LLP Post Office Box 810 Tallahassee, Florida 32302-0810 Steven A. Grigas, Esquire Heidi Hughes, Esquire Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building III Tallahassee, Florida 32308 Sam Power, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building III Tallahassee, Florida 32308 Julie Gallagher, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building III Tallahassee, Florida 32308
Conclusions This cause came before the Agency for Health Care Administration for issuance of a Final Order. 1. On March 26, 2013, the Agency sent a letter to the Petitioner notifying the Petitioner that it owed an overpayment in the amount of $565,279.55 to the Agency based upon an adjustment in the Petitioner’s overpayment rates (Exhibit A). 2. On April 16, 2013, the Petitioner filed a Petition for Formal Hearing and the Agency Clerk referred the Petition for Formal Hearing to the Division of Administrative Hearings for further proceedings. 4. On May 13, 2013, the Administrative Law Judge assigned to the case entered an Order Closing File and Relinquishing Jurisdiction based upon a Joint Motion to Relinquish Jurisdiction filed by the parties. 5. On May 23, 2014, the Agency rescinded the overpayment letter (Exhibit B). 6. The Agency’s rescission of the overpayment letter has rendered this matter moot. Filed August 14, 2014 9:26 AM Division of Administrative Hearings Based on the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: Respondent’s right to a hearing in this matter has been rendered moot and the Agency’s May 11, 2013 overpayment letter is rescinded. The parties shall govern themselves accordingly. DONE AND ORDERED this S day of Novurt , 2014 in Tallahassee, Leon County, Florida. K ELIZABETH DUDEK, SECRETARY AGENCY FOR HEALTH CARE ADMINISTRATION
