Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement, attached as Exhibit “1.” Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the /S Hay of Kfar . 2014, in Tallahassee, Florida. XN eth A fe. Agency for Health Care Administration Filed April 16, 2014 10:25 AM Division of Administrative Hearings A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHING 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Horace Dozier Field Office Manager 2727 Mahan Drive, MS 6 Tallahassee, Florida 32308 (Via Interoffice Mail) Julie Gallagher, Esquire Akerman Senterfitt 106 East College Avenue Suite 1200 Tallahassee, Florida 32301 (Via US Mail) Shena Grantham, Esquire Agency for Health Care Administration 2727 Mahan Drive, MS 3 Tallahassee, Florida 32308 (Via Interoffice Mail) Eric Miller, Inspector General Agency for Health Care Administration 2727 Mahan Drive Building 2, MS 4 Tallahassee, Florida 32308 (Via Interoffice Mail) Katherine B. Heyward, Esquire Agency for Health Care Administration 2727 Mahan Drive, MS 3 Tallahassee, Florida 32308 (Via Interoffice Mail) Agency for Health Care Administration Bureau of Finance and Accounting 2727 Mahan Drive Building 2, MS 14 Tallahassee, Florida 32308 (Via Interoffice Mail) Rick Zenuch, Chief Medicaid Program Integrity 2727 Mahan Drive Building 2, MS 6 Tallahassee, Florida 32308 (Via Interoffice Mail) Bureau of Health Quality Assurance 2727 Mahan Drive, MS 9 Tallahassee, Florida 32308 (Via Interoffice Mail) Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Via US Mail) Shawn McCauley, Medicaid Contract Manager Agency for Health Care Administration 2727 Mahan Drive, MS 22 Tallahassee, Florida 32308 (Via Interoffice Mail) iS) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to Richard Shoop, Esqu ire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No.: 12-193PH A Provider No.: 049207800 Cl. No.: 12-1060-000 DAVID M. KENTON, Respondent. / SETTLEMENT AGREEMENT. The STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “AHCA” or “the Agency”), and DAVID M. KENTON (hereinafter “Dr. Kenton”), by and through the undersigned, hereby stipulate and agree as follows: RECITALS A. These Recitals are true and correct to the best knowledge of the parties. B, AHCA is the single state agency responsible for Medicaid in the state of Florida. c. A Medicaid provider must enter into an agreement with AHCA in order to receive payments for services rendered under the Medicaid program. D. DAVID M, KENTON is a Medicaid provider in the State of Florida, provider number 049207800, E, On August 20, 2010, Dr. Kenton entered a plea of guilty to one count of conspiracy in violation of 18 U.S.C. Sec. 371; and on November 10, 2010, Dr. Kenton was found guilty of the charge in the United States District Court, Southern District of Florida, Case No. 09-60344-CR-MARRA, (26803191;1}Page 1 of 6 ea {2680319151} On November 30, 2011, AHCA sent Dr. Kenton a letter notifying him of AHCA’s intent to terminate for cause, pursuant to Florida Statute 409.913(13) and Rule 59G-9,070 Florida Administrative Code, his participation in the Medicaid program as a result of his conviction in the federal court action described above. On June 13, 2012, the State of Florida Board of Medicine (hereinafter “the Board”) entered a Final Order in DOH Case No, 2010-22219, Department of Health v. David Mitchell Kenton, M.D. pursuant to a Settlement Agreement. The Settlement Agreement provides, inter alia, that Dr. Kenton would be permitted to continue to practice medicine under certain terms and conditions; the Board allowed Dr. Kenton to renew his Florida medical license; and the Board recognized that Dr, Kenton was placed on the List of Excluded Individuals and Entities (LEIE) maintained by the Office of Inspector General with the Federal Department of Health and Human Services before that law, which would disqualify him from license renewal, became effective. On June 21, 2012, Dr. Kenton filed a request for hearing in this matter. The Parties have agreed to settle the matter addressed in the recitals, By execution of this Settlement Agreement, the parties affirm, warrant and represent that they have full and complete authority to enter into this Settlement Agreement and settle the matters addressed herein. AGREEMENT In consideration of the mutual promises and agreements set forth herein, the Parties agree as follows 1. {26803191,1} The parties agree that Dr. Kenton shall be immediately terminated from the Florida Medicaid program and that the termination shall be for “no cause.” Dr, Kenton agrees that the thirty (30) day notice period from the date of the November 30, 2011 termination letter has run. Dr, Kenton agrees that he will never again apply to the Florida Medicaid program regardless of his status with the Office of the Inspector General with the Federal Department of Health and Human Services. Dr. Kenton agrees that, regardless of his status with the Office of the Inspector Genera! with the Federal Department of Health and Human Services, AHCA has full discretion to deny any application Dr. Kenton submits to the Florida Medicaid program regardless of the reason for such denial. Dr. Kenton agrees to reimburse AHCA five thousand ($5,000.00) dollars for costs incurred in this matter. Dr, Kenton agrees to pay the costs within sixty (60) days of the date of the Final Order herein, This Agreement is expressly contingent upon the condition that neither Dr. Kenton nor anyone in his immediate family (to include any spouse, child, or parent of Dr. Kenton) shall own a health care facility within the State of Florida. Payment shall be made to: AGENCY FOR IIEALTH CARE ADMINISTRATION Medicaid Accounts Receivable 2727 Mahan Drive, M.S. #14 Tallahassee, Florida 32308-5403 9. Failure to pay the costs within the said sixty (60) days shall result in this Settlement Agreement being nul! and void and the case shall return to is pre- settlement status, 9. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the rules of the Medicaid Program, and all other applicable rules and regulations. 10. Other than the cost reimbursement provided for herein, each party shal! bear its own attorney's fees and costs. IL. This settlement docs not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter, The costs reimbursed by Dr. Kenton are not a sanction or penalty. 12, The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. 13. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be the Circuit Court located in Leon County, Florida. 14, This Agreement constitutes the entire agreement between Dr. Kenton and AHCA, including anyone acting for, associated with or employed by them, concerning all matters, and this Agreement supersedes any prior discussions, agreements of understandings; there are no promises, representations or agreements between Dr. Kenton {2680319151} and AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties, 15. This is an Agreement of Settlement and Compromise, made in recognition that the parties may have different or incorrect understandings, information, and contentions as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 16. Dr. Kenton expressly waives in this matter his right to any hearing pursuant to Sections 120.569 or 120.57, Florida Statutes, any making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which he may be otherwise entitled to under the law or the rules of the Agency regarding this proceeding and the issues raised herein. Dr. Kenton further agrees that he shall not challenge or contest any Final Order entered in this matter which is adopts the terms of this Settlement Agreement in any forum available to it now or in the future, including its right to any administrative proceeding, circuit or federal court action, or any appeal. 17. This Agreement is and shall be deemed jointly drafted and written by all parties to it, and shall not be construed or interpreted against the party originating or preparing it. 18, To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. (26803191;1} fl { 19, Ths Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees. 20. All times stated herein ate of the essence in this Agreement. 21, This Agreement shall be in full force and effect upon execution by the respective parties, Dated: Oetemhat 37 2013 Dated: Wy 2013 106 East College Avenne, Ste. 1200 Tallahassee, FL 32301 Attorney for Respondent AGENCY FOR HEALTH CARE , ; ; ADMINISTRATION a 2727 Mahan Drive, Bldg. 3, Mail Stop #3 seg, FL 32308-54 - ; ye ‘ Dated: 4, Sy ‘Lr a ies, ’ / . . , Erle Miller oS Inspector Gprietgl a oa o> en y freA 6m ee Dated: Stuart Williams, Esq. 0 Dated: Al & af fof General Counsel Chief Medicaid ounsel ; ave a nae oats Fyesl Y, _e oe ~ : ‘ oy Shena L. Grant Esq. oo , {26800911} -,
Conclusions THE PARTIES resolved all disputed issues and executed a Stipulation and Agreement. The parties are directed to comply with the terms of the attached stipulation and agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the 1i f- day of CJcfi>bA,y- , 2009, in Tallahassee, Florida. Filed October 12, 2009 11:40 AM Division of Administrative Hearings. DOAH Cases No. 09-0355MPI and 09-0359RU AHCA v. HEARTLAND and HEARTLAND v. AHCA Final Order w-JL H?LLY BENSON, sbARY Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Debora E. Fridie, Esq. Agency for Health Care Administration (Interoffice Mail) William M. Furlow, III, Esquire Metzger, Grossman, Furlow & Bayo, LLC 1408 North Piedmont Way Tallahassee, Florida 32308 (U.S. Mail) The Honorable Daniel Manry Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Kenneth Yon, Bureau Chief, MPI Agency for Health Care Administration (Interoffice Mail) Peter H. Williams, Inspector General Agency for Health Care Administration (Interoffice Mail) Finance and Accounting Agency for Health Care Administration Page 2 of3 DOAH Cases No. 09-0355MPI and 09-0359RU AHCA v. HEARTLAND and HEARTLAND v. AHCA Final Order CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail and/or Interoffice Mail on this the / y of Richard Shoop, Esquire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Page 3 of3 7 /i 7 /2009 1::.a PH Fl\OM: 863-J8f,-8t44 Heartland Int •·n;,l Med TO: 1- ;.o-:,ss-1953 PAGE: 002 OF 011 STATE OF FLORIDA DIVISION PF ADMfN!STRATIVE 1-mARfNGS
The Issue The issues in this case are whether Respondent, Carlos S. Contreras, M.D., violated Section 458.331(1)(c), Florida Statutes (2008), as alleged in the Administrative Complaint, filed with Petitioner, the Department of Health, on August 31, 2009, in DOH Case Number 2008-14221, and, if so, what disciplinary action should be taken against his license to practice medicine in the State of Florida.
Findings Of Fact The Parties. Petitioner, the Department of Health (hereinafter referred to as the "Department"), is the agency of the State of Florida charged with the responsibility for the investigation and prosecution of complaints involving physicians licensed to practice medicine in Florida. § 20.43 and Chs. 456 and 458, Fla. Stat. Respondent, Carlos S. Contreras, M.D., is, and was at all times material to this matter, a physician licensed to practice medicine in Florida pursuant to Chapter 458, Florida Statutes, having been issued license number 43908, on or about May 19, 1984. Indictment and Conviction of Dr. Contreras. On or about June 2, 2008, Dr. Contreras was indicted in United States of America v. Carlos Contreras and Ramon Pichardo, United States District Court, Southern District of Florida, Case No. 08-20443 CR - Moreno (hereinafter referred to as the "Indictment"). Generally, the Indictment alleges that Dr. Contreras was involved in a conspiracy to submit fraudulent claims to Medicare for purported Human Immunodeficiency Virus infusion therapy. As it relates to Dr. Contreras, the Indictment was predicated, in part, upon the following “General Allegation”: C.N.C. Medical Corp. (“CNC Medical”) was a Florida corporation, purportedly doing business at 1393 S.W. 1st Avenue, Suite #320, Miami, Florida. . . . CNC Medical was a medical clinic that purported to specialize in treating patients with HIV by providing infusion therapy. From in and around November 2002 through in or around April 2004, approximately $6.8 million in claims were submitted to the Medicare program for HIV infusion services allegedly rendered at CNC Medical. Defendant CONTRARES, a resident of Miami-Dade County, was a medical doctor who purported to order and provide HIV infusion services to Medicare beneficiaries at CNC Medical. CONTRERAS was also the president, director, and registered agent of CNC Medical. Relevant to this matter, Count 2 of the 12-Count Indictment charged Dr. Contreras with conspiracy to commit health care fraud in violation of 18 U.S.C. § 1349 On or about September 11, 2008, Dr. Contreras entered into a Plea Agreement in which he pled guilty to Count 2 of the Indictment, thereby admitting that he was guilty of “knowingly and willfully conspiring with others to execute a scheme and artifice to defraud and to obtain by means of materially false and fraudulent pretenses, representations, and promises money owned by, and under the custody and control of a health care benefits program (as defined as [sic] in Title 18, United States Code, Section 24(b)), in violation of Title 18, United States Code, Section 1347.” On the same date that the Plea Agreement was executed, Dr. Contreras, along with his legal representative, executed and acknowledged the following “Agreed Factual Basis for Guilty Plea”: Beginning in approximately November 2002, and continuing through approximately April 2004, the defendant, Dr. Carlos Contreras (“Contreras”), willfully conspired with his co-defendants, Ramon Pichardo, Carlos Benitez, Luis Benitez, Thomas McKenzie, and others to commit health care fraud, in violation of 18 U.S.C. § 1349. Medicare is a “health care benefit program” of the United States, as defined in 18 U.S.C. § 24. Furthermore, Medicare is a health care benefit program affecting commerce. Contreras was a medical doctor and owned a medical clinic named CNC Medical Corp. (“CNC”). At CNC, Contreras also employed Dr. Ramon Pichardo. CNC purported to specialize in treating patients with Human Immunodeficiency Virus (“HIV”). From approximately November 2002 through approximately April 2004, Contreras approved approximately $6.8 million worth of fraudulent medical bills, signed documents containing false information about treatments purportedly provided to HIV patients, and approved medically unnecessary treatments. As a result of Contreras’ conduct, the Medicare Program (“Medicare”) paid approximately $4.2 million worth of fraudulent bills to CNC and Contreras. CNC was a Florida corporation purportedly doing business at 1393 S.W. 1st Street, Suite #320, Miami, Florida. Corporate records display a business address of 1383 S.W. 1st Street, Suite #320, Miami, Florida. From approximately November 2002 through approximately April 2004, CNC billed the Medicare Program approximately $6.8 million under Contreras’ Medicare provider number, and actually received approximately $4.2 million in payments. Contreras signed checks drawn on CNC bank accounts and would use these checks to transfer funds to various corporate entities owned and controlled by Carlos and Luis Benitez, and others. In total, Contreras transferred approximately $1.7 million dollars [sic] to the Benitez brothers. In or about November 2002, Contreras agreed with his co-conspirators, including Dr. Ramon Pichardo, Carlos Benitez, Luis Benitez, and Thomas McKenzie, to accept HIV patients at CNC and to allow fraudulent bills to be submitted to the Medicare Program under his provided number. Co- conspirators Carlos Benitez and Luis Benitez agreed to provide the staff necessary to operate CNC as an HIV infusion clinic, the Medicare patients that CNC would utilize to bill to the Medicare program, and the transportation for the HIV patients, in return for a share of CNC’s profits. At that time, Contreras knew that CNC would need to pay kickbacks to the patients who visited the clinics, and that the CNC would bill Medicare for HIV infusion services three times a week, for up to three months, for each patient. Contreras’s primary job at the CNC was to see patients, sign medical records, and approve expensive and medically unnecessary HIV infusion treatments. Prior to purportedly treating HIV patients at CNC, Contreras worked at one other Benitez controlled HIV infusion therapy clinic, named AH Medical Office, Inc. At th[is clinic], he learned from the Benitez brothers and McKenzie how to make medical records appear legitimate and how to authorize treatments and sign medical analysis and diagnosis forms for HIV patients, without regard to medical necessity or the patients’ particular ailments. Contreras authorized and approved the use of the drug WinRho (also known as Rho D), along with a mix of various vitamin supplements for most HIV patients he was seeing, knowing that the HIV patients did not need WinRho. . . . . The Agreed Factual Basis for Guilty Plea executed by Dr. Contreras contained the following acknowledgement just above his signature: The preceding statement is a summary, made for the purpose of providing the Court with a factual basis for my guilty plea to the charges against me. It does not include all of the facts known to me concerning criminal activity in which I and others engaged. I make this statement knowingly and voluntarily and because I am in fact guilty of the crimes charged. On or about November 20, 2008, Dr. Contreras entered a plea of “guilty” to Count 2 of the Indictment. The court adjudicated him guilty, dismissed the other charges, and sentenced Dr. Contreras consistent with the Plea Agreement. At the time of the final hearing of this matter, Dr. Contreras was in the custody of the United States Bureau of Prisons serving a 37-month sentence. Based upon the admissions contained in the Agreed Factual Basis for Guilty Plea quoted in Finding of Fact 8, it is clear that the crime for which Dr. Contreras’ was adjudicated guilty involved a conspiracy in which he actually engaged in health care fraud, and not just a plan to do so. The Relationship of Dr. Contreras’ Convictions to the Practice of Medicine. In light of Dr. Contreras’ guilty plea to Count 2 of the Indictment and his acknowledgement of the Agreed Factual Basis for Guilty Plea, there is no doubt that Dr. Contreras engaged in the activities outlined in the Agreed Factual Basis for Guilty Plea. It is also clear that all of those activities related to the practice of medicine. As the Department points out in Petitioner’s Proposed Recommended Order, “[b]ut for Respondent’s license to practice medicine in the state of Florida, he would not have been able to commit the crimes [sic] for which he pled guilty. It was his license to practice medicine that allowed him to work as a physician at CNC Medical Corp., to obtain a [Medicare] provider number, to see patients, to sign medical records, to approve expensive and medically unnecessary HIV infusion treatments and to fully participate in the Medicare program. The foregoing activities were made possible and were a direct result of his status as a licensed Florida physician.” Without his license to practice medicine, there could have been no conspiracy to commit health care fraud. Dr. Contreras relies upon a number of “facts” in support of his argument that the crime for which he pled guilty does not relate directly to the practice of medicine: First, Dr. Contreras argues that the crime involved “conspiracy” to commit health care fraud rather than the actual act of health care fraud. Even if technically correct, the Agreed Factual Basis for Guilty Plea clearly outlines activities involving medical care necessary for the conspiracy to exist. Additionally, but for his license to practice medicine, there would have been no conspiracy; Secondly, Dr. Contreras points out that no restrictions were placed on his practice of medicine or his involvement in the Medicare Program or the Medicaid Program in the Plea Agreement. While correct, the emphasis of the criminal matter was on Dr. Contreras’ activities relating to defrauding the United States government of millions of dollars, rather than his activities as a physician. The government’s interest was a financial one and, therefore, it correctly left his actual practice of medicine to the governmental agencies charged with the responsibility of regulating the practice of medicine; Thirdly, Dr. Contreras points out that the Plea Agreement makes no mention of any breach of the physician- patient relationship. Again, the emphasis of the criminal matter was on Dr. Contreras’ efforts to “steal” government funds rather than the quality or lack thereof of his medical care; and Finally, Dr. Contreras relies upon the testimony of Joseph S. Rosenbaum, Esquire, who represented Dr. Contreras in the criminal matter. According to Dr. Contreras, Mr. Rosenbaum’s testimony was presented in order to “explain the meaning of the documents and background (facts) of the underlying criminal case.” According to Mr. Rosenbaum, Dr. Contreras was “’duped’” and “’used’ by unscrupulous businessmen more clever and ruthless then the Respondent.” Mr. Rosenbaum’s testimony, for which little in the way of predicate was offered, is rejected as contrary to the facts stipulated to by Dr. Contreras quoted in Finding of Fact 8. The crime for which Dr. Contreras was convicted is a crime that “directly relates to the practice of medicine.”
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the a final order be entered by the Board of Medicine finding that Carlos S. Contreras, M.D., has violated Section 458.331(1)(c), Florida Statutes, as described in this Recommended Order, permanently revoking his license to practice medicine in Florida, and imposing a fine of $10,000.00. DONE AND ENTERED this 22nd day of April, 2010, 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 22nd day of April, 2010. COPIES FURNISHED: Ephraim D. Livingston, Esquire Department of Health 4052 Bald Cypress Way, Bin C65 Tallahassee, Florida 32399-3265 Craig Brand, Esquire Brand Law Firm, P.A. 2816 East Robinson Street, Second Floor Orlando, Florida 32802 Larry McPherson, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399-3265 Dr. Ana M. Viamonte Ros, Secretary Department of Health 4052 Bald Cypress Way, Bin A00 Tallahassee, Florida 32399-1701 Josefina M. Tamayo, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 R. S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact At all times relevant hereto Lawrence D. Urban was a licensed osteopathic physician in Florida having been issued license number OS 001232. From January 1983 through at least March 17, 1984, Respondent maintained offices in Clearwater and Zephyrhills. He practiced in the Clearwater office on Monday, Wednesday and Friday of each week and in the Zephyrhills office on Tuesday, Thursday and Saturday. Respondent employed Wendell Bloom to work in the Zephyrhills office as a business manager and assistant to Respondent. Bloom had no medically related license such as physician's assistant, nurse, technician, etc. As an assistant to Respondent, Bloom drew blood, performed vascular analyses, mixed IV solutions, and administered IV solutions. He worked at the Zephyrhills office Monday through Friday. Bloom had standing orders from Respondent that if a new patient came in Bloom would draw a blood sample, send it to the lab for analysis and make an appointment for the patient to see Respondent when the results of the blood analysis was received. Respondent described his practice in Zephyrhills as holistic, involving nutrition, chelation, and cancer therapy using laetril. Chelation treatment involves the intravenous injections of solutions containing EDTA (Ethylenadiaminetetracetic acid), vitamins, including B12, B complex and C, and the minerals, calcium and magnesium. On many occasions Bloom commenced IV chelation injections containing EDTA before Respondent arrived at the office and completed some of these after Respondent had left the office. On at least five (5) occasions Bloom injected patients with IV solutions containing EDTA without Respondent being present any time during the procedure. Drawing blood without a doctor present in the office constitutes the practice of medicine. Injecting IV solutions in patients constitutes the practice of medicine without a doctor present. In the Zephyrhills office Respondent referred to Bloom as Dr. Bloom in the presence of patients. No sign or disclaimer was posted in the office that Bloom had no prior medical training and was not licensed in any medically related health professional field in Florida. Respondent knew that patients might believe Bloom to be a medical doctor. In administering an IV solution to a patient there is always a danger of an allergic reaction or an anaphylactic reaction, even if a patient has previously tolerated the treatment. Respondent acknowledged that serious side affects would result to a patient receiving an IV solution containing EDTA if the patient suffered kidney failure. Bloom also operated the vascular analyzer machine in the office. As described by Bloom, by attaching clips from the machine to the fingers and toes the machine will tell you if there is any kind of clotting or obstruction any place within the cardiovascular system. Further, by putting transmission gel on the clip and holding it over an artery, transmissions from the clip with the return echo is transformed onto a chart which will denote the elasticity of the artery. This machine is not universally accepted in the medical profession. By Final Order entered August 26, 1983 (Exhibit 1) the Florida Board of Osteopathic Medical Examiners found Respondent guilty of filing false reports, fee splitting, and abetting an unlicensed person to practice osteopathic medicine. He was sentenced to a reprimand, placed on probation for six (6) months and directed to report to the Board at the end of the probationary period. If, at this time, Respondent's report on the status of his practice satisfies the Board that the financial aspects of his practice is in accordance with the law, the reprimand will be withdrawn. Terms and conditions of the probation were not delineated. Respondent appeared before the Board at its March 17, 1984 meeting. After Respondent reported that the financial aspects of his practice were poor, but in conformity with the law, one of the Board members inquired if Respondent was working with any non-osteopathic physicians in his practice, which was one of the accusations for which he was reprimanded and placed on probation. At this point Respondent told the Board that he had a helper who was a "non- anything" who was drawing blood, doing vascular analyses of patients, giving IVs to patients undergoing chelation therapy and whatever Respondent told him to do. (Exhibit 2) After hearing these disturbing facts the Board voted to extend the Respondent's probation while an investigation of his practice was conducted. The charges considered at this hearing were those resulting from that investigation.
The Issue The issues in the case are whether certain provisions of the Florida Medicaid Hospital Services Coverage and Limitations Handbook (Handbook) that exclude non-emergent services rendered in the emergency room from covered Medicaid outpatient services and require revenue Code 451 to be billed with CPT Code 99281 constitute an invalid exercise of delegated legislative authority within the meaning of Subsection 120.56(3), Florida Statutes (2010).1
Findings Of Fact AHCA is the Medicaid agency for the State of Florida as provided under federal law. § 409.901(2), Fla. Stat. “'Medicaid agency' . . . means the single state agency that administers or supervises the administration of the state Medicaid plan under federal law." § 409.901(15), Fla. Stat. AHCA must administer the Medicaid program pursuant to a state plan that is approved by the Center for Medicare and Medicaid Services (CMS). 42 U.S.C. §§ 1396 and 1396a(a). AHCA reimburses Medicaid providers in accordance with state and federal law, according to methodologies set forth in rules promulgated by AHCA and in policy manuals and handbooks incorporated by reference in the rules. AHCA has adopted Florida Administrative Code Rule 59G-6.030, which incorporates by reference the Florida Title XIX Outpatient Hospital Reimbursement Plan, Version XIX (the Outpatient Plan), with an effective date of July 1, 2009. Reimbursement to participating outpatient hospitals, such as Petitioners, is to be provided in accordance with the Outpatient Plan. AHCA has issued the Florida Medicaid Hospital Services Coverage and Limitations Handbook. The Handbook is incorporated by reference in Florida Administrative Code Rule 59G-4.160. The Outpatient Plan and the Handbook identify those outpatient hospital services that are covered by the Medicaid program by revenue code. Only those revenue codes listed in Appendix A of the Outpatient Plan (Appendix A) and Appendix B of the Handbook (Appendix B) are covered outpatient services. Petitioners have challenged the following provisions of the Handbook: Handbook at page 2-7: EMTALA Medical Screening Exam The federal Emergency Medical Treatment and Labor Act (EMTALA) requires emergency rooms to conduct a medical screening exam on any patient presenting to the emergency room for medical services . . . . If the medical screening exam determines that no emergency medical condition exists, Florida Medicaid reimburses only for the screening and the ancillary services required to make the determination (e.g., lab work or x-rays). Medicaid policy does not provide for reimbursement of non-emergency services beyond the medical screening exam required by EMTALA. Handbook at page 2-40: Non-Emergency Care in the Emergency Room Medicaid policy does not provide for reimbursement of non-emergency services beyond the medical screening exam required by Emergency Medical Treatment and Labor Act (EMTALA). EMTALA requires emergency rooms to conduct a medical screening exam on any patient presenting to the emergency room for medical services. The purpose of the medical screening exam is to determine if an emergency medical condition exists. If the screening determines that an emergency medical condition exists, the provider must either stabilize the condition or appropriately transfer the patient to a facility that can stabilize the condition. If the medical screening determines that no emergency medical condition exists, Florida Medicaid reimburses only for the screening and the ancillary services required to make the determination (e.g., lab work or x-rays). Recipients are responsible for a coinsurance on such claims. Handbook, Appendix B at pages B-6 and B-7: EMERGENCY ROOM 0450 General Classification Use General Classification code 0450 when recipients require emergency room care beyond the EMTALA emergency medical screening services. Code 0450 cannot be used in conjunction with 0451 (99281). All other appropriate and covered outpatient revenue codes can be billed with 0450 to reflect services rendered to the patient during the course of emergency room treatment. No MediPass authorization is required when billing 0450, if the type of admission in Form Locator 19 on the claims is "1" (Emergency). MediPass authorization is required when the condition of the patient is not an emergency. 0451(99281) EMTALA Emergency Medical Screening Services (Effective 7/1/96) Report the EMTALA Medical Screening code 0451 (99281) when, following the screening and exam, no further emergency room care or treatment is necessary. If ancillary services are not necessary to determine whether or not emergency or further treatment is required, report the ancillary charges using the appropriate revenue center codes in conjunction with code 0451 (99281). Note that 0451 (99281) cannot be used in conjunction with 0450. Effective 10/16/03, HCPCs code 99281 replaces code W1700, used prior to 10/16/03, when billing revenue code 0451. Florida Administrative Code Rule 59G-4.160 provides that the specific authority for the promulgation of the rule is Section 409.919, Florida Statutes, and the law implemented is Sections 409.905, 409.908, and 409.9081, Florida Statutes. Petitioners are acute care hospitals that are and were enrolled as Medicaid providers of outpatient service in Florida at all times material to this proceeding.
Findings Of Fact Based upon the evidence adduced at hearing, the parties' prehearing stipulation, and the record as a whole, the following Findings of Fact are made: Respondent is now, and has been for approximately the past 15 years, a physician licensed to practice medicine in the State of Florida. He specializes in internal medicine and cardiology and is board certified in these specialities. He currently is the Chief of Cardiology and head of the Coronary Care Unit at North Ridge Hospital and has staff privileges at approximately five other hospitals in the Broward County area. At all times material to the instant case, Health Imaging, Inc., (Health) was in the business of providing ultrasound imaging services in the State of Florida at the request of physicians, hospitals and members of the community at large. The tests performed by Health were non-invasive studies that involved no health risks. They included echocardiograms, carotid ultrasounds and other studies of the heart and vascular system done with ultrasound equipment. Unlicensed technicians operated the equipment and administered the tests. Florida-licensed physicians interpreted the test results. In August of 1987, Warren Green and his wife, the owners of Health, contacted Respondent and asked him if he would be interested in contracting with Health to provide such interpretive and diagnostic services. After looking into the matter and satisfying himself that Health's equipment was of good quality and that its technicians were well qualified, Respondent entered into a written agreement (Agreement) with Health, the body of which provided as follows: This agreement made and entered into this 18 day of August 1987 by and between Health Imaging, having its principal business address at 6278 North Federal Highway, Suite 372, Ft. Lauderdale, Florida, hereinafter referred to as "HEALTH" and Jorge Flores, M.D., having his principal business address at 5700 N. Federal Highway, Ft. Lauderdale, Florida, hereinafter referred to as "DOCTOR" is made with reference to the following: WHEREAS, HEALTH is engaged in business throughout the Florida area providing ultrasound and vascular services to hospitals, physician offices and the community. DOCTOR is engaged in the business of providing medical services to his patients and patients of other doctors and hospitals in the Ft. Lauderdale, Florida area. Health desires to contract from DOCTOR for certain diagnostic interpretation services for its own patients and patients of other doctors and hospitals in the Florida area. NOW THEREFORE, HEALTH AND DOCTOR AGREE AS FOLLOWS: Equipment. HEALTH agrees to provide all necessary equipment and supplies to perform the services according to the schedule set forth on Exhibit A, attached hereto. Personnel. Health shall provide qualified technologists to operate the equipment for the services set forth on Schedule A, attached hereto. Solicitation of Employees. DOCTOR shall not during the term of this agreement nor a period of One (1) year after its termination, solicit for employment or employ, whether as employee or independent contractor, any person who is or has been employed by HEALTH during the term of this agreement without the prior written consent of HEALTH. Physician Interpretation Personnel. DOCTOR agrees to provide necessary qualified physicians for interpretations. Payment. For and in consideration of the services and promises contained herein by DOCTOR, HEALTH agrees to pay DOCTOR in accordance with the fee schedule set forth on Schedule A, attached hereto. All fees are to be paid in advance or at time of interpretation. Default. In the event of the default of any payment this contract may be terminated by DOCTOR. Term, Termination. The term of this agreement is for one (1) year. After Thirty (30) days either party may terminate this agreement, without cause, by giving Thirty (30) days written notice provided that in no event may HEALTH terminate this agreement unless all monies owing to DOCTOR under the terms hereof are paid in full. Compliance with Law. Both parties agree to comply with all municipal, state and federal laws and regulations. Governing Law. This agreement shall be construed under the laws of the State of Florida. Independent Contractor. DOCTOR is performing the service and duties required hereunder as an independent contractor and not as an employee, agent, partner, or joint venturer with HEALTH. Entire Agreement. This instrument shall be deemed to contain the entire agreement between HEALTH and DOCTOR and supercedes [sic] any prior or existing agreements, understandings, arrangements, terms, conditions, negotiations, or representations, oral or written, made by either party concerning or affecting the subject matter hereof. No modification of this agreement may be made except in writing, signed by HEALTH and DOCTOR. Schedule A, which was referenced in and appended to the Agreement, read as follows: INTERPRETATION FEE SCHEDULE Community, Corporate, Club and Association Screening Program Fee Schedule. EXAM: Echocardiography only FEE: One thousand dollars (1,000.00) per month for 400 studies in any thirty (30) day period. Five dollars ($5.00) per study for all studies exceeding four Hundred (400) studies in any given thirty (30) day period. Community, Corporate, Club and Association Screening Program Fee Schedule. EXAMS: (Any combination of the following) Carotid Ultrasound with Doppler and Periorbital Doppler Echocardiography Upper and Lower Extremity Doppler Study FEE: Three thousand dollars ($3,000.00) per month for any combination of the above studies, not to exceed 1,500 studies in any thirty (30) day period. Any combination of the above studies will be at a rate of Five Dollars ($5.00) per study in any given thirty (30) day period. Hospital and Physician offices fee Schedule: (Any studies performed in a hospital or Physician office, ordered by a physician) EXAMS Carotid ultrasound with doppler $65.00 Echocardiography $65.00 Abdominal ultrasound $65.00 Holter monitoring $65.00 Peripheral arterial examination $35.00 Peripheral venous examination $35.00 The Agreement and Schedule A were drafted by the Greens without the assistance of an attorney. Respondent furnished Health with interpretive and diagnostic services under the Agreement for approximately 18 months. He provided Health with no other services. Respondent was compensated $1,000 per month the first four months and $3,000 per month the remaining 14 months for his services. Most of the individuals whose test results Respondent interpreted during his 18-month association with Health were self-referred. The remainder of the test takers were referred by physicians. None had any prior professional relationship with Respondent. 1/ Respondent prepared a signed, written report of his findings for each test taker. 2/ He sent the report, along with the materials that he had reviewed in making his findings, to Health, which in turn provided the report to the test taker or to the referring physician, if there was one. 3/ Respondent did not consider the test takers to be his patients. He therefore did not keep copies of the reports he had prepared and sent to Health or the test materials upon which these reports had been based. 4/ The Greens had assured Respondent at the outset, however, that they would maintain these records and make them available to Respondent upon his request should he need them for some reason. The Greens were true to their word. Whenever Respondent asked to see a copy of a report or test materials, 5/ the Greens complied with his request. The Greens still have in their possession copies of the reports Respondent had prepared and transmitted, as well as the related test materials. While Respondent was aware that Health advertised to generate business, he was not asked to assist in any way, either as a consultant or otherwise, in the preparation or placement of any of Health's advertisements. Indeed, the first time he saw one of these advertisements was approximately five or six months after he began his association with Health. The advertisement was in a local newspaper that he happened to be reading. Some months later he saw another advertisement in the same newspaper. He found the contents of this particular advertisement to be "totally unacceptable." He therefore telephoned the Greens and complained about the advertisement. The Greens responded to Respondent's complaint by discontinuing the advertisement. A short time thereafter, upon the suggestion of a Department investigator who warned Respondent "to stay away from these people," Respondent severed his relationship with Health. He did so, not because he believed that he had done anything wrong, but because the Department, through its investigator, had expressed its concerns regarding the matter.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board of Medicine enter a final order dismissing the Amended Administrative Complaint in its entirety. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 15th day of January, 1993. STUART M. LERNER 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 15th day of January, 1993.
The Issue Whether the Petitioner must reimburse the Respondent for Medicaid overpayments as set out in the Amended Final Agency Audit Report dated November 13, 2000, and, if so, the amount to be repaid.
Findings Of Fact Based on the oral and documentary evidence presented at the final hearing and on the entire record of this proceeding, the following findings of fact are made: The Agency is the state agency responsible for the administration of the Medicaid program in Florida, and, as one of its duties, the Agency is charged with recovering overpayments made to Medicaid providers. Section 409.913, Florida Statutes (2000). At all times material to this proceeding, Peripheral Medical Services provided durable medical equipment and home health services to Medicaid recipients in Florida pursuant to a contract with the Agency, and it was assigned Medicaid provider number 950348000.2 The Medicaid Provider Agreement entered into by Peripheral Medical Services provides in pertinent part: The Provider agrees to participate in the Florida Medicaid program under the following terms and conditions: * * * (5) The Medicaid provider shall: * * * (b) Keep and maintain in a systematic and orderly manner all medical and Medicaid related records as the Agency may require and as it determines necessary; make available for state and federal audits for five years, complete and accurate medical, business, and fiscal records that fully justify and disclose the extent of the goods and services rendered and billings made under the Medicaid program. The provider agrees that only contemporaneously made records of goods and services provided will be admissible in evidence in any proceeding relating to payment for or provision of services for the purpose of supporting any claim submitted to or paid by the Medicaid program. After the Agency received a routine report from its Medicaid Program Office located in Miami, Florida, the Agency conducted an audit of the claims submitted by Peripheral Medical Services for the 27 Medicaid recipients to whom it provided oxygen durable medical equipment and services during the audit period extending from August 5, 1996, to July 6, 1998. Pursuant to certificates of medical necessity, Peripheral Medical Services provided each of the 27 Medicaid recipients with an oxygen concentrator during the audit period, and it submitted Medicaid claims for monthly visits to each of these patients. During the period of time covered by the audit, Peripheral Medical Services received payments for services provided to the 27 Medicaid recipients in an amount totaling $76,926.74. Peripheral Medical Services maintained patient records for these 27 Medicaid recipients, and, during the audit, it provided the Agency with the patient records as documentation to support the claims. At the times material to this proceeding, the DME/Medical Supply Services Coverage and Limitations Handbook governing "Oxygen and Oxygen Related Equipment" provided in pertinent part: "Monthly Home Visit Requirements: When the CRTT, RRT or RN conducts a home visit, the following information about the recipient's condition and the condition of the equipment must be documented in the recipient's record: . . . the monthly checks of the operation and safety of the equipment." The Agency's inspector compared the patient records to the list of claims submitted by Peripheral Medical Services for which it received payment from Medicaid, and he reached the following conclusions, which were memorialized in the audit work papers and the summary report he prepared: Peripheral Medical Services made 21 claims for payment for monthly visits to patient M.C., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 14 of the visits; $3,639.90 of the $6,106.80 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 12 claims for payment for monthly visits to patient C.M., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at eight of the visits; $2,498.20 of the $3,747.30 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 14 claims for payment for monthly visits to patient J.P-O., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at eight of the visits; $2,498.20 of the $4,340.55 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 13 claims for payment for monthly visits to patient F.A., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at eight of the visits; $2,361.63 of the $3,915.18 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 20 claims for payment for monthly visits to patient N.V., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 12 of the visits; $3,595.18 of the $6,061.98 paid by Medicaid was not supported by documentation. Peripheral Medical Services made ten claims for payment for monthly visits to patient M.P., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at six of the visits; $1,325.22 of the $2,270.36 paid by Medicaid was not supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient M.A., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient M.B., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made 21 claims for payment for monthly visits to patient R.Q., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 15 of the visits; $4,172.69 of the $6,015.04 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 19 claims for payment for monthly visits to patient M.P., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 12 of the visits; $3,975.64 of the $5,833.64 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 11 claims for payment for monthly visits to patient E.D., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at six of the visits; $1,813.19 of the $3,366.74 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 15 claims for payment for monthly visits to patient I.S., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at ten of the visits; $2,679.60 of the $4,233.15 paid by Medicaid was not supported by documentation. Peripheral Medical Services made five claims for payment for monthly visits to patient R.G., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at any of the visits; the entire $1,522.25 paid by Medicaid was not supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient R.B., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made two claims for payment for monthly visits to patient A.A., but it failed to provide documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at one of the visits; $320.10 of the $640.20 paid by Medicaid was not supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient L.B., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made 20 claims for payment for monthly visits to patient D.C., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 14 of the visits; $3,868.24 of the $5,726.24 paid by Medicaid was not supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient D.M., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient K.R., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made 16 claims for payment for monthly visits to patient D.G., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at ten of the visits; $2,954.88 of the $4,812.88 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 23 claims for payment for monthly visits to patient M.V., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 15 of the visits; $4,172.69 of the $6,639.59 paid by Medicaid was not supported by documentation. Peripheral Medical Services made one claim for payment for a monthly visit to patient L.F., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. Peripheral Medical Services made six claims for payment for monthly visits to patient R.N., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at any of the visits; the entire $1,920.60 paid by Medicaid was not supported by documentation. Peripheral Medical Services made 22 claims for payment for monthly visits to patient T.P., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at 15 of the visits; $4,172.69 of the $6,335.14 paid by Medicaid was not supported by documentation. Peripheral Medical Services made nine claims for payment for monthly visits to patient A.V., but it failed to provide documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at eight of the visits; $1,889.30 of the $2,102.70 paid by Medicaid was not supported by documentation. Peripheral Medical Services made two claims for payment for monthly visits to patient R.P., and it provided documentation establishing that checks of the operation and safety of the oxygen concentrators were performed at these visits; the payments made by Medicaid were supported by documentation. aa. Peripheral Medical Services made one claim for payment for a monthly visit to patient E.R., and it provided documentation establishing that a check of the operation and safety of the oxygen concentrators was performed at this visit; the payment made by Medicaid was supported by documentation. The patient records provided by Peripheral Medical Services do not contain documentation that the required operation and safety checks were performed in the months identified by the Agency in its audit work papers, and the Agency's calculations of the amounts paid by Medicaid that are subject to recoupment are supported by the summary report prepared by the Agency's inspector, as well as by the Agency's summary report. Peripheral Medical Services received payments totalling $49,380.20 from Medicaid on claims not supported by documentation.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a final order finding that Peripheral Medical Services, Inc., was overpaid for services provided to Medicaid recipients for the audit period extending from August 5, 1996, to July 6, 1998, and requiring Peripheral Medical Services, Inc., to repay the Agency for Health Care Administration the principal amount of $49,380.20. DONE AND ENTERED this 8th day of November, 2001, in Tallahassee, Leon County, Florida. PATRICIA HART MALONO 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 8th day of November, 2001.
