Findings Of Fact At all times pertinent to the issues herein either the Florida Department of Health and Rehabilitative Services, (Department), or the Florida Agency for Health Care Administration, (Agency), its successor agency, operated the Medicaid Program in Florida, a state and federally funded program to provide medical services to indigent and eligible individuals, including children, in Florida. Petitioner, Neonatology Associates, Inc., (NAI), is a provider to the Medicaid Program of the State of Florida, and is located in St. Petersburg, Florida. Its Medicaid provider number is 067920-01. It has been a Medicaid provider for approximately thirty years. Medicaid and Children's Medical Services (CMS) were, at one time, both separate components of the Department of Health and Rehabilitative Services. On July 1, 1993, responsibility for Medicaid was assigned to the Agency for Health Care Administration. Medicaid, and its fiscal agent, FMMIS, are not now and never have been a part of either Children's Medical Services or Regional Perinatal Intensive Care Center (RPICC) and neither CMS nor RPICC have ever been a part of Medicaid or its fiscal agent. RPICC serves only peripherally to Medicaid as a claims transmittal agency or billing agent. That relationship was formalized by a contract which is considered by FMMIS as a billing agent contract. The parties stipulated prior to the hearing that the medical services, which are represented by Petitioner to have been performed were actually performed and rendered, and that all of the patients for the disputed claims are assumed to be Medicaid eligible. The parties stipulated at the hearing that the five claims were submitted by Petitioner to RPICC in a timely manner; that the five claims were received by RPICC within a twelve month period from the date of service; that there was a problem at RPICC which precluded the transmittal of these five claims in a timely manner to the Florida Medicaid Management Information System, (FMMIS), the office with which they were to be filed for payment; and that there was communication by telephone and in person between officials of Petitioner, RPICC, and the Department/Agency, (CMS), in an effort to resolve the filing difficulty. These claims relate to five patients, M.H., M.C., C.J., B.A. and R.W. Claims which are not received by Medicaid or its fiscal agent within twelve months of service may not be paid pursuant to law described in the trade as the "twelve month rule." The five claims in issue here were transmitted electronically to RPICC by NAI's agent, Ms. Chandler, the RPICC billing clerk at All Children's Hospital, where the service was rendered, for subsequent re- transmittal by RPICC to FMMIS. This procedure is authorized by the Agency. However, due to technical problems not further identified, the claims were never received by FMMIS. RPICC, a part of the Department's Children's Medical Services, and operated by the University of Florida, does not adjudicate claims but merely gathers and analyzes neonatology data for statistical reporting. FMMIS, Medicaid's fiscal agent since July 1, 1993, is operated by a private vendor. The contract between Medicaid and the University under which RPICC data services are provided, and that between NAI and Medicaid, which provides for medical services, both contain the same "boiler plate" clauses. Both NAI and RPICC transmit electronic claims to Medicaid for adjudication, but neither is a party of or agent of Medicaid. FMMIS is Medicaid's agent for payment. RPICC data processing services charges are paid to the University of Florida by Children's Medical Services under their contract. Medicaid pays only for the actual medical care provided to indigent mothers and their sick newborn children. NAI has a contract with Medicaid. RPICC has a contract with Medicaid. Children's Medical Services has a contract with RPICC at the University of Florida. These are the only formal agreements involved in this situation. The contract between NAI and Medicaid provides that NAI will submit Medicaid claims "in accordance with program policies." Medicaid policy provides that receipt of electronic claims submission to Medicaid or its fiscal agent, FMMIS, takes place only upon acceptance and confirmation by FMMIS. Acceptance occurs when each claim is assigned its own identification number. Medicaid policy also provides that submittal of a claim to RPICC does not constitute receipt of the claim by Medicaid or its fiscal agent, and submittal of a claim to RPICC does not toll the running of time accounted for under the twelve month rule. The relationship between Medicaid and the RPICC data center may be likened to that of RPICC's being a billing transmittal agent for FMMIS. RPICC does not process claims submitted to it but merely forwards those it receives to the fiscal agent which operates the FMMIS. Medicaid, by letter from Mr. Thomas Arnold, dated March 5, 1990, authorized FMMIS to receive Medicaid claims from RPICC. That letter does no more than offer providers an option to have RPICC bill the fiscal agent for them, thereby creating a "billing agent" status for RPICC. It does not state that submittal of claims by providers to RPICC constitutes filing a claim with Medicaid or the fiscal agent so as to toll the running of the twelve months limit. The Medicaid Physician Provider Handbook made available to all providers expressly states that all claim inquiries be made to Consultec, a private computer services provider. Both Mr. Blasioli and the Agency's regional claims representative noted that NAI did not contact Consultec regarding the computer problems regarding the instant claims prior to the expiration of the twelve month claim filing limit. Neither did NAI make use of RPICC's internal claims tracking system during the period in issue. The evidence establishes that NAI experienced difficulty in submitting the five claims in issue. Nonetheless, within a month of being employed by NAI, its billing administrator advised Medicaid that he had addressed the problem and had established procedures with RPICC's data center to prevent future claims from exceeding the twelve month limit. NAI's difficulty with the five claims in issue were first brought to the attention of Medicaid personnel after the twelve month filing limit had expired. Though the claims in issue here were submitted electronically, NAI could have submitted these claims directly to FMMIS by traditional paper claim, omitting the RPICC channel and its potential for technical problems. It chose not to do so. The "twelve month rule" provides for exceptions which are expressly limited to those claims which are delayed by either legal action or lack of proof of recipient eligibility. An additional exception is afforded claims delayed by "crossovers" with Medicare. The rule does not provide for extension of time due to computer system error unless such error relates to processing errors which arise subsequent to Medicaid's acknowledgment of claim receipt. In essence, to justify an exception to the twelve month rule, the computer error must be Medicaid's. The Medicaid program cannot deviate from federally imposed requirements. Should it do so, it faces the potential loss of federal expenditure reimbursement which constitutes fifty-five percent of all money spent by Florida in its operation of the Medicaid program. The program processes 100,000,000 claims annually from more than 60,000 providers, paying out approximately $6,700,000,000 each year. Even minor exceptions to the rules governing the adjudication process could have extensive impact on and consequences to the program and the benefits it imparts to the indigent health care recipients it serves.
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 denying as untimely Petitioner's five claims in issue. DONE and ENTERED this 22nd day of May, 1996, in Tallahassee, Florida. ARNOLD H. POLLOCK, 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 22nd day of May, 1996. APPENDIX TO RECOMMENDED ORDER, CASE NO. 95-3049 To comply with the requirements of Section 120.59(2), Florida Statutes (1993), the following rulings are made on the parties' proposed findings of fact: Petitioner's Proposed Findings of Fact. 1. - 3. Accepted and incorporated herein. First sentence accepted. Balance accepted as definitions, not Findings of Fact. - 12. Accepted. Merely a restatement of testimony in support of Petitioner's position. Not a proper Finding of Fact. Accepted. Rejected as no more than a comment on the evidence and a statement of party position. - 20. Accepted as a statement of position, but rejected as probative of any material factual issue. 21. - 24. Accepted. Accepted. & 27. Not Findings of Fact but citations of statute. 28. & 29. Accepted. Not Findings of fact but cites of agency rule. A restatement of Handbook matter. Accepted. - 35. Accepted. Accepted but non-probative argument. Rejected as contra to the weight of the evidence. - 43. Accepted. Not a Finding of Fact but a restatement of testimony. - 49. Accepted. 50. & 51. Accepted and incorporated herein. 52. - 55. Accepted. 56. - 58. Accepted. 59. & 61. Accepted, but no evidence exists that RPICC's actions constitute receipt of the claim. The evidence of record better suggests that RPICC receives information from providers based upon which it acts as billing agent for the provider and it remains incumbent upon the provider to insure it gets the pertinent information to RPICC in sufficient time for the claim to be billed within the tweleve month constrains. 62. - 65. Rejected as contra to the better evidence of record. Respondent's Proposed Findings of Fact. 1. & 2. Accepted and incorporated herein. Not a Finding of Fact but a restatement of the issue. - 7. Accepted and incorporated herein. 8. & 9. Accepted. 10. - 14. Accepted. Accepted. - 18. Accepted. 19. & 20. Accepted and incorporated herein. Not a Finding of Fact but a restatement of and comment on testimony. & 23. Accepted and incorporated herein. 24. Accepted but not probative of any material issue of issue of fact. COPIES FURNISHED: Frank P. Rainer, Esquire Ruden, McClosky, Smith, Schuster, and Russell, P.A. 215 South Monroe Street, Suite 815 Tallahassee, Florida 32310 Mark S. Thomas, Esquire Agency for Health Care Administration 2727 Mahan Drive, Suite 3407 Tallahassee, Florida 32308 Sam Power Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Tallahassee, Florida 32308 Jerome W. Hoffman General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32309
The Issue Whether Petitioner's Medicaid Waiver Services Agreement should be terminated with cause by Respondent Agency for Persons with Disabilities.
Findings Of Fact The Agency for Health Care Administration ("AHCA") is Florida's designated Medicaid agent pursuant to chapter 409, Florida Statutes. In that role, AHCA has delegated duties with respect to the MWSA to Agency for Persons with Disabilities ("APD" or "Respondent"). APD ensures that Medicaid waiver providers comply with applicable Medicaid rules. To ensure compliance, APD enters into a MWSA with providers to facilitate payment. AHCA pays the providers for services rendered according to the MWSA. On April 22, 2015, Petitioner entered into a MWSA with Respondent. As a qualified provider, the MWSA allowed Petitioner to perform services for APD clients and get paid through the Medicaid program by reimbursement. Section I.B. of the MWSA provides: Prior to executing this Agreement and furnishing any waiver services, the Provider must have executed a Medicaid Provider Agreement with the Agency for Health Care Administration (AHCA), and be issued a Medicaid provider number by AHCA. The Provider must at all times during the term of this Agreement maintain a current and valid Medicaid Provider Agreement with AHCA, and comply with the terms and conditions of the Medicaid Provider Agreement. On or about August 3, 2017, AHCA terminated Petitioner's Medicaid Provider Agreement and notified Petitioner by letter that "Medicaid will no longer pay for claims for reimbursement for goods or services that you furnish." APD investigated AHCA's termination and concluded that Petitioner did not comply with section I.B. of the MWSA that required Petitioner to maintain a current and valid Medicaid Provider Agreement with AHCA. On October 5, 2017, by letter, APD terminated Petitioner's MWSA pursuant to section III.B., which provides Petitioner's "agreement may be terminated for the Provider's unacceptable performance, non-performance or misconduct." APD's letter detailed the basis for Petitioner's termination as follows: Provider's Medicaid Provider Number was terminated by the Agency for Health Care Administration (AHCA) on September 2, 2017. Therefore, the Provider is not performing in accordance with the MWSA, Section I., B., which requires that "The Provider must at all times during the term of this Agreement, maintain a current and valid Medicaid Provider Agreement with AHCA, and comply with the terms and conditions of the Medicaid Provider Agreement. At hearing, Petitioner admitted that Respondent terminated the MWSA when APD became aware of ACHA's termination. Petitioner also acknowledged that Miracles House, Inc., has been unable to bill since ACHA suspended its services, but Whipple is contesting ACHA's actions. On or about October 27, 2017, Petitioner challenged APD's termination and timely requested a formal hearing.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Persons with Disabilities enter a final order terminating Petitioner's Medicaid Waiver Services Agreement. DONE AND ENTERED this 23rd day of May, 2018, in Tallahassee, Leon County, Florida. S JUNE C. MCKINNEY 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 23rd day of May, 2018. COPIES FURNISHED: Adres Jackson-Whyte, Esquire 10735 Northwest 7th Avenue Miami, Florida 33168 (eServed) Trevor S. Suter, Esquire Agency for Persons with Disabilities 4030 Esplanade Way, Suite 315C Tallahassee, Florida 32399-0950 (eServed) Gypsy Bailey, Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 335E Tallahassee, Florida 32399-0950 (eServed) Richard D. Tritschler, General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 (eServed) Barbara Palmer, Director Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 (eServed)
The Issue Whether Medicaid overpayments were made to Respondent and, if so, what is the total amount of those overpayments. Whether, as a "sanction," Respondent should be directed to submit to a "comprehensive follow-up review in six months."
Findings Of Fact Based upon the evidence adduced at hearing, and the record as a whole, the following findings s of fact are made to supplement and clarify the factual stipulations set forth in the parties' Joint Prehearing Stipulation and their January 26, 2007, pleading:4 Respondent and his Practice Respondent is a pediatric physician whose office is located in a poor neighborhood in Hialeah, Florida. He has a very busy practice, seeing approximately 50 to 60 patients each day the office is open. Respondent documents patient visits by making handwritten notations on printed "progress note" forms. Because of the fast-paced nature of his practice, he does not always "have time to write everything as [he] would like, because [there] is too much" for him to do. Respondent's Participation in the Medicaid Program During the Audit Period, Respondent was authorized to provide physician services to eligible Medicaid patients. Respondent provided such services pursuant to a valid Provider Agreement (Provider Agreement) with AHCA, which contained the following provisions, among others: The Provider agrees to participate in the Florida Medicaid program under the following terms and conditions: * * * Quality of Services. The provider agrees to provide medically necessary services or goods of not less than the scope and quality it provides to the general public. The provider agrees that services or goods billed to the Medicaid program must be medically necessary, of a quality comparable to those furnished by the provider's peers, and within the parameters permitted by the provider's license or certification. The provider further agrees to bill only for the services performed within the specialty or specialties designated in the provider application on file with the Agency. The services or goods must have been actually provided to eligible Medicaid recipients by the provider prior to submitting the claim. Compliance. The provider agrees to comply with all local, state and federal laws, rules, regulations, licensure laws, Medicaid bulletins, manuals, handbooks and Statements of Policy as they may be amended from time to time. Term and signatures. The parties agree that this is a voluntary agreement between the Agency and the provider, in which the provider agrees to furnish services or goods to Medicaid recipients. . . . Provider Responsibilities. 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. The provider agrees that only records made at the time the goods and services were provided will be admissible in evidence in any proceeding relating to the Medicaid program. * * * (d) Except as otherwise provided by law, the provider agrees to provide immediate access to authorized persons (including but not limited to state and federal employees, auditors and investigators) to all Medicaid- related information, which may be in the form of records, logs, documents, or computer files, and all other information pertaining to services or goods billed to the Medicaid program. This shall include access to all patient records and other provider information if the provider cannot easily separate records for Medicaid patients from other records. * * * (f) Within 90 days of receipt, refund any moneys received in error or in excess of the amount to which the provider is entitled from the Medicaid program. * * * (i) . . . . The provider shall be liable for all overpayments for any reason and pay to the Agency any fine or overpayment imposed by the Agency or a court of competent jurisdiction. Provider agrees to pay interest at 12% per annum on any fine or repayment amount that remains unpaid 30 days from the date of any final order requiring payment to the Agency. * * * Respondent's Medicaid provider number (under which he billed the Medicaid program for providing these services) was (and remains) 370947700. Handbook Provisions The handbooks with which Petitioner was required to comply in order to receive Medicaid payment for services rendered during the Audit Period included the Medicaid Provider Reimbursement Handbook, HCFA-1500 (MPR Handbook); Physician Coverage and Limitations Handbook (PCL Handbook); the Early and Periodic Screening, Diagnosis and Treatment Coverage and Limitations Handbook (EPSDTCL Handbook); and the Child Health Check-up Coverage and Limitations Handbook (CHCUCL Handbook). Medical Necessity The PCL Handbook provided that the Medicaid program would reimburse physician providers for services "determined [to be] medically necessary" and not duplicative of another provider's service, and it went on to state as follows: In addition, the services must meet the following criteria: the services must be individualized, specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient's needs; the services cannot be experimental or investigational; the services must reflect the level of services that can be safely furnished and for which no equally effective and more conservative or less costly treatment is available statewide; and the services must be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider. The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such care, goods or services medically necessary or a covered services. Note See Appendix D, Glossary, in the Medicaid Provider Reimbursement Handbook, HCFA-1500 and EPSDT 224, for the definition of medically necessary.[5] The EPSDTCL and CHCUCL Handbooks had similar provisions. Documentation Requirements The MPR Handbook required the provider to keep "accessible, legible and comprehensible" medical records that "state[d] the necessity for and the extent of services" billed the Medicaid program and that were "signed and dated at the time of service." The handbook further required, among other things, that the provider retain such records for "at least five years from the date of service" and "send, at his or her expense, legible copies of all Medicaid-related information to the authorized state and federal agencies and their authorized representatives." The MPR Handbook warned that providers "not in compliance with the Medicaid documentation and record retention policies [described therein] may be subject to administrative sanctions and recoupment of Medicaid payments" and that "Medicaid payments for services that lack required documentation or appropriate signatures will be recouped." EPSDT Screening/Child Health Check-Up The EPSDTCL Handbook provided: To be reimbursed by Medicaid, the provider must address and document in the recipient's medical record all the required components of an EPSDT screening. The following required components are listed in the order that they appear on the optional EPSDT screening form: Health and developmental history Nutritional assessment Developmental assessment Physical examination Dental screening Vision screening Hearing screening Laboratory tests Immunization Health education Diagnosis and treatment The CHCUCL Handbook, which replaced the EPSDTCL Handbook in or around May 2000, similarly provided as follows: To be reimbursed by Medicaid, the provider must assess and document in the child's medical record all the required components of a Child Health Check-Up. The required components are as follows: Comprehensive Health and Developmental History, including assessment of past medical history, developmental history and behavioral health status; Nutritional assessment; Developmental assessment; Comprehensive Unclothed Physical Examination Dental screening including dental referral, where required; Vision screening including objective testing, where required; Hearing screening including objective testing, where required; Laboratory tests including blood lead testing, where required; Appropriate immunizations; Health education, anticipatory guidance; Diagnosis and treatment; and Referral and follow-up, as appropriate. Coding Chapter 3 of the PCL Handbook "describe[d] the procedure codes for the services reimbursable by Medicaid that [had to be] used by physicians providing services to eligible recipients." As explained on the first page of this chapter of the handbook: The procedure codes listed in this chapter [were] Health Care Financing Administration Common Procedure Coding System (HCPCS) Levels 1, 2 and 3. These [were] based on the Physician[]s['] Current Procedural Terminology (CPT) book. The Current Procedural Terminology (CPT) book referred to in Chapter 3 of the PCL Handbook was a publication of the American Medical Association. It contained a listing of procedures and services performed by physicians in different settings, each identified by a "procedure code" consisting of five digits or a letter followed by four digits. For instance, there were various "procedure codes" for office visits. These "procedure codes" included the following, among others: New Patient * * * 99204 Office or other outpatient visit for the evaluation and management of a new patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. * * * Established Patient * * * 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. * * * Fee Schedules In Appendix J of the PCL Handbook, there was a "fee schedule," which established the amount physicians would be paid by the Medicaid program for each reimbursable procedure and service (identified by "procedure code"). For both "new patient" office visits (99201-99205 "procedure code" series) and "established patient" office visits (99211-99215 "procedure code" series), the higher numbered the "procedure code" in the series, the more a physician would be reimbursed under the "fee schedule." The Audit and Aftermath Commencing in or around August 2002, AHCA conducted an audit of Respondent's Medicaid claims for services rendered during the Audit Period (Audit Period Claims).6 Respondent had submitted 18,102 such Audit Period Claims, for which he had received payments totaling $596,623.15. These Audit Period Claims involved 1,372 different Medicaid patients. From this group, AHCA randomly selected a "cluster sample" of 40 patients. Of the 18,102 Audit Period Claims, 713 had been for services that, according to the claims, had been provided to the 40 patients in the "cluster sample" (Sample Claims). Respondent had received a total of $23,263.18 for these 713 Sample Claims. During an August 28, 2002, visit to Respondent's office, AHCA personnel "explain[ed] to [Respondent] what the audit was about [and] why [AHCA] was doing it" and requested Respondent to provide AHCA with copies of the medical records Respondent had on file for the 40 patients in the "cluster sample" documenting the services provided to them during the Audit Period. The originals of these records were not inspected by AHCA personnel or agents during, or any time after, this August 28, 2002, site visit. Sometime within approximately 30 to 45 days of the August 28, 2002, site visit, Respondent, through his office staff, made the requested copies (First Set of Copies) and provided them to AHCA. There is nothing on the face of these documents to suggest that they were not true, accurate, and complete copies of the originals in Respondent's possession, as they existed at the time of copying (Copied Originals). They do not appear, upon visual examination, to be the product of "bad photocopying." While the handwritten entries and writing are oftentimes difficult (at least for the undersigned) to decipher, this is because of the poor legibility of the handwriting, not because the copies are faint or otherwise of poor quality. Each of the Sample Claims was reviewed to determine whether it was supported by information contained in the First Set of Copies. An initial review was conducted by AHCA Program Analyst Theresa Mock and AHCA Registered Nurse Consultant Blanca Notman. AHCA then contracted with Larry Deeb, M.D., to conduct an independent "peer review" in accordance with the provisions of Section 409.9131, Florida Statutes. Since 1980, Dr. Deeb has been a Florida-licensed pediatric physician, certified by the American Board of Pediatrics, in active practice in Tallahassee. AHCA provided Dr. Deeb with the First Set of Copies, along with worksheets containing a "[l]isting of [a]ll claims in [the] sample" on which Ms. Notman had made handwritten notations indicating her preliminary determination as to each of the Sample Claims (Claims Worksheets). In conducting his "peer review," Dr. Deeb did not interview any of the 40 patients in the "cluster sample," nor did he take any other steps to supplement the information contained in the documents that he was provided. Dr. Deeb examined the First Set of Copies. He conveyed to AHCA his findings regarding the sufficiency of these documents to support the Sample Claims by making appropriate handwritten notations on the Claims Worksheets before returning them to AHCA. Based on Dr. Deeb's sufficiency findings, as well as Ms. Notman's "no documentation" determinations, AHCA "provisional[ly]" determined that Respondent had been overpaid a total $80,788.23 for the Audit Period Claims. By letter dated July 7, 2003 (Provisional Agency Audit Report), AHCA advised Petitioner of this "provisional" determination and invited Respondent to "submit further documentation in support of the claims identified as overpayment," adding that "[d]ocumentation that appear[ed] to be altered, or in any other way appear[ed] not to be authentic, [would] not serve to reduce the overpayment." Appended to the letter were "[t]he audit work papers [containing a] listing [of] the claims that [were] affected by this determination." In the Provisional Agency Audit Report, AHCA gave the following explanation as to how it arrived at its overpayment determination: REVIEW DETERMINATION(S) Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. The documentation you provided supports a lower level of office visit than the one for which you billed and received payment. The difference between the amount you were paid and the correct payment for the appropriate level of service is considered an overpayment. Medicaid policy specifies how medical records must be maintained. A review of your medical records revealed that some services for which you billed and received payment were not documented. Medicaid requires documentation of the services and considers payment made for services not appropriately documented an overpayment. Medicaid policy addresses specific billing requirements and procedures. You billed Medicaid for Child Health Check Up (CHCUP) services and office visits for the same child on the same day. Child Health Check- Up Providers may only bill for one visit, a Child Health Check-Up or a sick visit. The difference between the amount you were paid and the appropriate fee is considered an overpayment. The overpayment was calculated as follows: A random sample of 40 recipients respecting whom you submitted 713 claims was reviewed. For those claims in the sample which have dates of service from January 01, 2000 through December 31, 2001 an overpayment of $4,168.00 or $5.84667601 per claim was found, as indicated on the accompanying schedule. Since you were paid for a total (population) of 18,102 claims for that period, the point estimate of the total overpayment is 18,102 x $5.84667601= $105,836.33. There is a 50 percent probability that the overpayment to you is that amount or more. There was then an explanation of the "statistical formula for cluster sampling" that AHCA used and how it "calculated that the overpayment to [Respondent was] $80,788.23 with a ninety-five percent (95%) probability that it [was] that amount or more." After receiving the Provisional Agency Audit Report, Respondent requested to meet with Dr. Deeb to discuss Dr. Deeb's sufficiency findings. The meeting was held on September 25, 2003, approximately six months after Dr. Deeb had reviewed the First Set of Copies and a year after AHCA had received the First Set of Copies from Respondent. At the meeting, Respondent presented to Dr. Deeb what Respondent represented was a better set of copies of the Copied Originals than the First Set of Copies (on which Dr. Deeb had based the sufficiency findings AHCA relied on in making its "provisional" overpayment determination). According to Respondent, the First Set of Copies "had not been properly Xeroxed." He stated that his office staff "had not copied the back section of the documentation and that was one of the major factors in the documentation not supporting the [claimed] level of service." The copies that Respondent produced at this meeting (Second Set of Copies) had additional handwritten entries and writing (both on the backs and fronts of pages) not found in the First Set of Copies: the backs of "progress note" pages that were completely blank in the First Set of Copies contained handwritten narratives, and there were handwritten entries and writing in numerous places on the fronts of these pages where, on the fronts of the corresponding pages in the First Set of Copies, just blank, printed lines appeared (with no other discernible markings). The Second Set of Copies was not appreciably clearer than the First Set of Copies. In the two hours that he had set aside to meet with Respondent, Dr. Deeb only had time to conduct a "quick[]," partial review of the Second Set of Copies. Based on this review (which involved looking at documents concerning approximately half of the 40 patients in the "cluster sample"), Dr. Deeb preliminarily determined to "allow" many of the Sample Claims relating to these patients that he had previously determined (based on his review of the First Set of Copies) were not supported by sufficient documentation. Following this September 25, 2003, meeting, after comparing the Second Set of Copies with the First Set of Copies and noting the differences between the two, AHCA "made the decision that [it] would not accept the [S]econd [S]et [of Copies]" because these documents contained entries and writing that appeared to have been made, not contemporaneously with the provision of the goods or services they purported to document (as required), but rather after the post-Audit Period preparation of the First Set of Copies. Instead, AHCA, reasonably, based its finalized overpayment determination on the First Set of Copies. Thereafter, AHCA prepared and sent to Respondent a Final Agency Audit Report, which was in the form of a letter dated June 29, 2004, advising Respondent that AHCA had finalized the "provisional" determination announced in the Provisional Agency Audit that he had been overpaid $80,788.23 for the Audit Period Claims (a determination that the preponderance of the record evidence in this case establishes is a correct one).
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that AHCA enter a final order finding that Respondent received $80,788.23 in Medicaid overpayments for the Audit Period Claims, and requiring Respondent to repay this amount to AHCA. DONE AND ENTERED this 30th day of April, 2007, in Tallahassee, Leon County, Florida. S STUART M. LERNER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 30th day of April, 2007.
The Issue The issue in this case is whether the parties’ agreement in paragraph 9 of the Medicaid Provider Agreement was to allow for arbitrary and capricious termination without cause.
Findings Of Fact On October 10, 1995, the Petitioner, Food With A Flair, Inc., entered into a Non-Institutional Professional and Technical Medicaid Provider Agreement (the Provider Agreement) with the Respondent, the Agency for Health Care Administration (the AHCA). Through this Provider Agreement, the Petitioner became a participant in the Florida Medicaid Program administered by the AHCA. The Petitioner’s role in the Program was to provide meals for the Program’s HIV clients. The Provider Agreement had 12 numbered paragraphs, 8 and 9 of which stated: The provider and the Agency agree to abide by the Florida Administrative Code, Florida Statutes, policies, procedures, manuals of the Florida Medicaid Program and Federal laws and regulations. The agreement may be terminated upon thirty days written notice by either party. The Agency may terminate this agreement in accordance with Chapter 120, F.S. During the time the Petitioner was providing meals under the Provider Agreement, the AHCA received complaints about the meals being provided by the Petitioner and the manner in which the Petitioner’s meals and services were being provided. Although the complainants have not been identified, some may have been competitors of the Petitioner, and some were anonymous. The AHCA investigated the complaints and decided that, if true, they were serious enough to warrant termination of the Petitioner’s Provider Agreement. However, the AHCA chose not to terminate the Petitioner’s Provider Agreement for cause out of concern that the release of the identity of some of the Program’s HIV clients would result, in violation of their legal rights to confidentiality. For that reason, the AHCA chose to terminate the Petitioner’s Provider Agreement without cause. The AHCA’s Notice of Termination issued on November 25, 1996, not only purported to terminate the Petitioner’s Provider Agreement “thirty days from receipt of this notice,” it also gave the Petitioner notice that it had “the right to request a hearing pursuant to Section 120.57, Florida Statutes.” The Provider Agreement was drafted by Unisys Corporation in consultation with the AHCA’s General Counsel. It is a form agreement, and the terms were not negotiable by the Petitioner. If the Petitioner wanted to participate in the Program, it had to accept the form agreement. The Provider Agreement was signed by Thomas Barcia as president/director of the Petitioner and by W. A. Hardy, Jr., apparently an employee of Unisys, on behalf of the AHCA. Neither Hardy nor the AHCA’s General Counsel testified at final hearing. Neither of the AHCA’s two witnesses could testify as to the meaning of the Provider Agreement, particularly paragraphs 8 and 9. Thomas Barcia testified that he understood the Provider Agreement to mean that the Petitioner could terminate on thirty days notice but that termination by the AHCA also had to be fair and for just cause and subject to due process; otherwise, he thought the Provider Agreement was to last for five years, or for as long as the Petitioner’s services were needed. In support of the Petitioner’s interpretation of the Provider Agreement, Barcia pointed to paragraph 1 of the Provider Agreement, which required the Petitioner to “keep for 5 years complete and accurate medical and fiscal records that fully justify and disclose the extent of the services rendered and billings made under the Medicaid program . . .” Barcia also testified that he and others made investments in the Petitioner’s business that would not have been made had they known that the AHCA could terminate the Provider Agreement without cause. He testified that major personal and corporate financial hardships would befall him and the Petitioner if the AHCA terminated the Provider Agreement on 30 days notice, including defaults on building and vehicle leases; he testified that personal and corporate bankruptcy could result.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the AHCA enter the final order reinstating the Petitioner’s Medicaid Provider Agreement without prejudice to possible proceedings to terminate the Provider Agreement for cause. RECOMMENDED this 16th day of June, 1997, at Tallahassee, Florida. J. LAWRENCE JOHNSTON Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 SUNCOM 278-9675 Fax FILING (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 16th day of June, 1997. COPIES FURNISHED: Gordon Scott, Esquire Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308-5403 R. Jeffrey Stull, Esquire Daniel R. Kirkwood, Esquire 602 South Boulevard Tampa, Florida 33606 Sam Power, Agency Clerk Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308-5403 Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308-5403
Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the QIhay of Qucenater > 201\, in Tallahassee, Florida. bd WM fer ELIZABETH DUDEK, SECRETARY Agency for Health Care Administration 1 Filed January 5, 2012 11:44 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 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: L. William Porter Assistant General Counsel Agency for Health Care Administration Office of the General Counsel (Interoffice) Carlos Muniz Deputy Attorney General/Chief of Staff Office of the Attorney General Department of Legal Affairs (electronic mail) Michael Verbitsky, President 2024 Hollywood Boulevard Hollywood, Florida 33020 (U.S. Mail) Eleanor M. Hunter Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Mike Blackburn, Bureau Chief, Medicaid Program Integrity Finance and Accounting Health Quality Assurance Department of Health 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, Laserfiche or electronic mail on this the fay of denne 2012. Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308-5403 (850) 412-3630/FAX (850) 921-0158 SETTLEMENT AGREEMENT THIS SETTLEMENT AGREEMENT (hereinafter referred to as “ Agreement”) is entered between the STATE OF FLORIDA, acting through its MEDICAID FRAUD CONTROL UNIT (hereinafter referred to as “MFCU”) of the OFFICE OF THE ATTORNEY GENERAL (hereinafter referred to as “OAG”) and WELLSCRIPTS, LLC (hereinafter referred to as “WELLSCRIPTS”) and MICHAEL VERBITSKY (bereinafter referred to as “VERBITSKY”), acting through its authorized representative. As a preamble to this Agreement, the MFCU, WELLSCRIPTS, and VERBITSKY agree to the following: A. “WELLSCRIPTS,” “VERBITSKY,” and “Parties” Defined: As used in this Agreement, the term “WELLSCRIPTS” is defined as WELLSCRIPTS, LLC, an inactive Florida for Limited Liability Company, its current and former parent entities, predecessors, successors, and assigns, including the agents, employees, officers, and directors, and independent contractors of WELLSCRIPTS, their successors and assigns, to the extent such agerits and independent contractors were acting for or on behalf of WELLSCRIPTS. WELLSCRIPTS was dissolved on September 26, 2008. VERBITSKY was the president and owner of WELLSCRIPTS during the Covered Conduct. Collectively, WELLSCRIPTS, VERBITSKY, and MFCU are the “Parties,” as used herein. B. “Investigation” of the “Covered Conduct”: The MFCU conducted an investigation of WELLSCRIPTS concerning WELLSCRIPTS’ alleged improper claims for and receipt of Medicaid payments from Florida’s Agency for Health Care Administration (hereinafter Page 1 of 11 referred to as “AHCA”). As used herein, the term “Investigation” shall mean MFCU’s investigation into WELLSCRIPTS. As a result of this investigation, the MFCU alleges that WELLSCRIPTS improperly billed the Florida Medicaid program $346,887.88 for certain drugs. This calculation was based on an audit of the top seven (7) drugs billed by Wellscripts. Also, the MFCU alleges that WELLSCRIPTS was improperly reimbursed for medications billed to two assisted living facilities totaling $17,139.16. WELLSCRIPTS submitted these claims through Medicaid Provider Number 0268208-00. The MFCU alleges that the total amount improperly billed by WELLSCRIPTS to Florida’s Medicaid program is $364,027.04. This MFCU-investigated conduct is the “Covered Conduct,” as used hereafter. The “Covered Conduct” does not include any conduct or potential claims that WELLSCRIPTS may have administratively against AHCA or any other entity for billed services which have not yet been paid that are outside the scope and/or time frame of the conduct detailed above. . MFCU’s Claims: MFCU contends it has certain statutory and common-law civil claims against WELLSCRIPTS as a result of the Covered Conduct. . Motivation to Resolve Claims: The Parties desire to conclude the aforementioned Investigation into the Covered Conduct and to settle and compromise on all claims, including, but not limited to, any claims pursuant to Sections 68.081 through 68.092 Florida Statutes, against WELLSCRIPTS arising out of the Investigation that the MFCU either asserted or maintained against WELLSCRIPTS or could have asserted or maintained against WELLSCRIPTS. The Parties enter into this full and final Agreement Page 2 of 11 to avoid the delay, uncertainty, inconvenience, and expense of protracted litigation of these claims. NOW, THEREFORE, in consideration of the premises and the mutual promises, agreements, obligations, and covenants set forth, and for good and valuable consideration as stated herein, the Parties agree as follows: 1, Settlement Terms: a. Settlement Amount: WELLSCRIPTS’ relinquishment of all rights and interests in the monies previously seized from Bank of America Account Number 003738055311 totaling $219,193.66 plus interest. The monies previously seized are currently being held in the OAG’s Trust Account. b. Return of Funds Seized: The OAG agrees to abandon the claim for forfeiture of the seized currency from Bank of America Account Numbers 003671024535 and 003672757995 in the names of Michael Verbitsky and Ricki R. Kaneti totaling $22,253.27 and will return the funds to Michael Verbitsky and Ricki R. Kaneti. The funds will be returned to Michael Verbitsky and Ricki R. Kaneti’s counsel via check to Nason, Yeager, Gerson, White & Lioce P.A.’s trust account at Sabadell United Bank, Account Number 0215000258. c, Upon the signing of this Agreement by both parties, the MFCU will transfer to AHCA, $219,193.66 plus interest to satisfy the Medicaid program loss. d. Upon the signing of this Agreement by both parties, OAG agrees to voluntarily dismiss the Civil Action case number 2010 CA 015157 (09), which was filed in the Seventeenth Judicial Circuit of Broward County, FL on April 6, 2010. OAG also agrees to voluntarily dismiss the Civil Forfeiture Action case number 2007 Page 3 of 11 CA 000765 (14), which was filed in the Seventeenth Judicial Circuit of Broward County, FL on January 11, 2007. 2. MFCU’s Release: Subject to the exceptions in Paragraph 3 (“Scope of Release”) and Paragraph 4 (“Bankruptcy Provisions”), upon full execution of this Agreement by all Parties and WELLSCRIPTS’ simultaneous remittance to the MFCU of the settlement amount as provided in Paragraph 1, the MFCU agrees to release WELLSCRIPTS from any and all civil and administrative actions, causes of action, obligations, liabilities, claims, or demands for compensatory, special, punitive, exemplary, or treble damages, or demand whatsoever in law or in equity, which were asserted or maintained or could have been asserted or maintained, against WELLSCRIPTS based upon or arising out of the Investigation of the Covered Conduct specifically as defined in Preamble Paragraph B. However, the Agreement will have no actual or intended effect until executed by MFCU’s authorized representative. In the event WELLSCRIPTS makes payment of the Settlement Amount prior to full execution of this Agreement, MFCU may deposit the Settlement Amount in an escrow account pending execution and such deposit shall not be construed as acceptance of the terms of this Agreement. 3. Scope of Release: Notwithstanding any term of this Agreement, the following are specifically reserved and excluded from the scope and terms of this Agreement as to any entity or person, including WELLSCRIPTS: a. MFCU, AHCA, or other appropriate law enforcement or regulatory agency or private party suit against WELLSCRIPTS or any predecessor, successor, director, officer, employee, assign or agent of WELLSCRIPTS for: Page 4 of 11 i. Any administrative or civil cause of action for any violation of law arising out of the covered conduct and not encompassed within the Investigation as defined in Preamble Paragraph B; or ii. Any criminal liability. Accordingly, WELLSCRIPTS agrees not to assert the defenses of res judicata, collateral estoppel, excessive fines, or double jeopardy as to actions described in subparagraphs (a)(1) and (a)(2) of this Paragraph 3. b. Any actions or matters involving the exclusion of WELLSCRIPTS or other entities or persons from Federal or State, including Florida, health care programs; c. Any administrative action(s) relating to professional licensure or adjudication of claims by persons or entities who are not parties to this Agreement; d. Any claims based upon such obligations as are created by this Agreement, e. Any liability to the State of Florida, including MFCU and OAG, for any conduct other than the Covered Conduct; f. Any express or implied warranty claims or other claims for defective or deficient products or services, including quality of goods and services, provided by WELLSCRIPTS; g. Any claims for personal injury or property damage or for other consequential | damages arising from the Covered Conduct; ! h. Any claims based on a failure to deliver items or services due; and i. Any action against a healthcare professional, including WELLSCRIPTS and any of its employees or agents, for practicing without the necessary license or certification. Page S$ of 11 . Bankruptcy Provisions: The Parties warrant and agree to the following bankruptcy provisions: a. WELLSCRIPTS warran ts that it has reviewed its own financial position and WELLSCRIPTS is solvent within the meaning of Title 11 of the United States Code §§547(b)(3) and 548 (a)(1)(B)Gi)@, and will remain solvent following its payment to the MFCU of the Settlement Amount. _ No Admission of Fault: This Agreement, any exhibit or document referenced herein, any action taken to reach, effectuate, or further this Agreement, and the terms set forth herein, shall not be construed as, or used as, an admission by or against any of the Parties of any fault, wrongdoing, or liability whatsoever. Entering into or carrying out this Agreement, or any negotiations or proceedings related thereto, shall not in any event be construed as, or deemed to be evidence of, an admission or concession by any of the Parties, or to be a waiver of any applicable defense. However, with the exception of certain bankruptcy provisions in Paragraph 4, nothing in this Agreement, including this Paragraph 5, shall be construed to limit or to restrict WELLSCRIPTS’ right to utilize this Agreement, or payments made hereunder, to assert and maintain the defenses of res judicata, collateral estoppel, payment, compromise and settlement, accord and satisfaction, or any legal or equitable defenses in any pending or future legal or administrative action or proceeding arising out of the specific subject matter of the Investigation, as defined in Preamble Paragraph B. WELLSCRIPTS does not admit MFCU’s contentions that arise from its Investigation of the Covered Conduct, set forth in Preamble Paragraph B, and specifically denies WELLSCRIPTS knowingly submitted any claims in Page 6 of 11 violation of state or federal law. This Agreement, and the payment, promises, and release provided hereunder, are not and shall not be construed to be an admission of liability or any acknowledgment of the validity of any of the claims that were or that could have been asserted by the MFCU against WELLSCRIPTS, arising out of the: Investigation, which liability or validity is hereby expressly denied by WELLSCRIPTS. . Denied Medical Claims: The Settlement Amount shall not be decreased as a result of the denial of claims for payment now being withheld from payment by AHCA or its intermediary agents related to the Covered Conduct. WELLSCRIPTS agrees not to resubmit to Medicare, Medicaid, or any State or Federal payer any previously denied claims related to the Covered Conduct and agrees not to appeal any such denials of claims. However, WELLSCRIPTS reserves the right to appeal and/or resubmit previously denied claims or seek administrative remedies with AHCA of those claims which are outside the scope of the Covered Conduct. . Complete Resolution: The Parties have agreed that the terms of this Agreement constitute a complete resolution and settlement of the claims asserted against WELLSCRIPTS by the MFCU, as well as the claims that could have been asserted against WELLSCRIPTS by the MFCU arising out of or as a result of the Investigation described in Preamble Paragraph B. Upon WELLSCRIPTS’ continued fulfillment of its obligations under this Agreement, and relinquishment of all rights and interests in the monies seized provided in Paragraph 1, the Investigation, as defined in Preamble Paragraph B, shall be concluded. Page 7 of 11 10. il. 12. 13, 14, Survival: This Agreement shal! be binding upon and inure to the benefit of the Parties and their successors, transferees, heirs, and assigns. Merger: This Agreement constitutes the entire agreement between the Parties with regard to the subject matter contained herein and all prior negotiations and understandings between the Parties shall be deemed merged into this Agreement. No External Representations: No representations, warranties, or inducements have been made by the MFCU concerning this Agreement other than those representations, warranties, and covenants contained in this Agreement. No Oral Modifications or Waivers: No waiver, modification, or amendment of the terms of this Agreement shall be valid or binding unless in writing, signed by the Party to be charged, and then only to the extent set forth in such written waiver, modification, or amendment. Failure of Strict Performance: Any failure by any Party to the Agreement to insist upon the strict performance by any other Party of any of the provisions of this Agreement shall not be deemed a waiver of any of the provisions of this Agreement, and such Party, notwithstanding such failure, shall have the right thereafter to insist upon the specific performance of any and all of the provisions of this Agreement. Choice of Law: This Agreement shall be governed by, and construed and enforced in accordance with the laws of the State of Florida, without regard to its conflict of law principles. Release of Florida; WELLSCRIPTS fully and finally releases the MFCU, the OAG, and the State of Florida, its agencies, employees, servants, and agents from any claims (including attorney’s fees and costs of any kind) that WELLSCRIPTS has Page 8 of 11 15. 16. 17. 18. asserted, could have asserted, or may assert in the future against the MEFCU, the OAG, or the State of Florida, its agencies, employees, and agents arising out of or resulting from the Investigation as defined in Preamble Paragraph B. Contract Beneficiaries: This Agreement is intended to be for the benefit of the Parties only and by this instrument the Parties do not release any claims against any other person or entity, except to the extent provided in the immediately preceding Paragraph 14. Contribution from Medical Beneficiaries: WELLSCRIPTS waives and shall not seek payment for any of the health care billings covered by this Agreement from any health care beneficiaries or their parents, sponsors, legally responsible individuals, or third party payers based upon the claims defined as Covered Conduct. Litigation Costs: With exception of investigative costs and litigation costs, which may be specifically provided for in Paragraph 1, each party to this Agreement shall bear its own legal and other costs incurred in connection with this matter, including the preparation and performance of this Agreement. Unenforceable Clause: Neither Party shall challenge the legality or enforceability of this Agreement. If any clause, provision, or section of this Agreement shall, for any reason, be held illegal, invalid, or unenforceable, such illegality, invalidity, or unenforceability shall not affect any other clause, provision, or section of this Agreement, and this Agreement shall be construed and enforced as if such illegal, invalid, or unenforceable clause, section, or other provision had not been contained herein. Page 9 of 11 19. 20. 21. 22. 23. 24. 25. Arm’s Length Negotiations: The Parties executed this Agreement after arm’s length negotiations and it reflects the conclusion of the Parties that this Agreement is in the best interest of all the Parties. Each Party is satisfied with the Agreement’s language and construction, and therefore the interpretation of the terms of this Agreement shall not be construed against any of the Parties. Each Party represents that this Agreement is freely and voluntarily entered into without any degree of duress or compulsion whatsoever. Authority to Execute Agreement: The undersigned individuals signing this Agreement on behalf of WELLSCRIPTS represent and warrant that they are authorized to execute this Agreement. The undersigned MFCU signatories represent that they are signing this Agreement in their official capacities and that they are authorized to execute this Agreement. Effective Date: This Agreement is effective on the date of signature of the last signatory to the Agreement (hereinafter referred to as the “Effective Date”). Non-Punitive Effect: The Parties agree that this Settlement is not punitive in purpose or effect. IRS Characterization: Nothing in this Agreement constitutes an agreement or representation characterizing the Settlement Amount for the purposes of the Internal Revenue Code, Title 26 of the United States Code. Public Disclosure: All Parties consent to the MFCU’s disclosure of this Agreement, and information about this Agreement, to the public. Introductory Signals: The introductory paragraph signals are for subject identification only and do not affect the meaning or become part of the Agreement. Page 10 of 11 WELLSCRIPTS, LLC FOR FLORIDA'S OFFICE OF THE ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS PAM BONDI ATTORNEY GENERAL AY C. A oa * 3 ™ Carlos Muniz “ ie . J f- Deputy Attorney General/Chief of Staff Position: f , eal 4h vali Date: Date: Page 1! of Il (Page 1 of 48) POROA AGENCY FOR HESLIA CARE ADMINSTRATION: JEB BUSH, GOVERNOR CHRISTA CALAMAS, SECRETARY CERTIFIED MAIL. — 91 7108 2133 3932 8581 4299 September 7, 2006 Provider No: 026820800 License No: PH20057 Mr. Michael Verbitsky Wellscripts LLC 2024 Hollywood Boulevard Hollywood, Florida 33020 In Reply Refer to FINAL AUDIT REPORT CL No. 06-4308-000/P/AAE Dear Mr. Verbitsky: The Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Integrity, has completed a review of claims for Medicaid reimbursement for dates of service during the period of December 1, 2004 through November 30, 2005. A preliminary audit report dated July 25, 2006 was sent to you indicating that we had determined you were overpaid $347,963.94. Based upon a review of all documentation submitted, we have determined that you were overpaid $347,963.94 for services that in whole or in part are not covered by Medicaid. A fine of $5,000.00 has been applied. The total amount due is $352,963.94. . Be advised of the following: (1) Pursuant to Section 409.913(23)(a), Florida Statutes (F.S.), the Agency is entitled to recover all investigative, legal, and expert witness costs. (2) In accordance with Sections 409.913(15), (16), and (17), F.S., and Rule 59G-9.070, Florida Administrative Code (F.A.C.), the Agency shall apply sanctions for violations of federal and state laws, including Medicaid policy. This letter shall serve as notice of the following sanction(s): ° A fine of $5,000.00 for violation of Rule Section 59G-9.070(7)(n), F.A.C. 2727 Mahan Drive « Mail Stop #4 Vallahassee, FL 32308 Visit AHCA online at www fdhe. state flus APPENDIX A (Page 2 of 48) Wellseripts LLC Page 2 of 4 This review and the determination of Overpayment were made in accordance with the provisions of Section 409.913, F.S. In determining the appropriateness of Medicaid payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies, limitations and requirements found in the Medicaid provider handbooks and Section 409.913, F.S, In applying for Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicable tules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines. Below is a discussion of the particular guidelines related to the review of your claims, and an explanation of why these claims do not meet Medicaid requirements. The audit work Papers are attached, listing the claims that are affected by this determination. REVIEW DETERMINATION(S) The audit included a comparison of your lawful documented product acquisitions with your paid Medicaid claims. Only product acquisitions from Florida licensed wholesalers were included in the review. The audit period for this review was from December 1, 2004 through November 30, 2005. The drug quantity paid for by Medicaid, in some instances, exceeded the quantity available to dispense to Medicaid recipients. This review identified an overpayment of $347,963.94. Enclosed for this revicw are the overpayment calculations which include the summary sheet(s), the paid claims data, and acquisition data. If you are currently involved in a bankruptcy, you should notify your attorney immediately and provide a copy of this letter for them. Please advise your attorney that we nced the following information immediately: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division). If you are not in bankruptcy and you concur with our findings, remit by certified check in the amount of $352,963.94, which includes the Overpayment amount as well as any fines imposed. The check must be payable to the Florida Agency for Health Care Administration. Questions regarding procedures for submitting payment should be directed to Medicaid Accounts Receivable, (850) 488- 5869. ‘To ensure proper credit, be certain you legibly record on your check your Medicaid provider number and the C.I. number listed on the first page of this audit report. Please mail payment to: Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32317-3749 If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(27), F.S. Furthermore, pursuant to Sections 409.913(25) and 409.913(15), F.S., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may result in termination from the Medicaid Program. Likewise, failure to comply with all sanctions applied or due dates may result in additional sanctions being imposed. (Page 3 of 48) Wellscripts LLC Page 3 of 4 You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. Ifa request for a formal hearing is made, the petition must be made in compliance with Section 28- 106.201, F.A.C. and mediation may be available. Ifa request for an informal hearing is made, the petition must be made in compliance with rule Section 28-106.301, F.A.C. Additionally, you are hereby informed that if'a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of receipt of this letter. For more information regarding your hearing and mediation rights, please see the attached Notice of Administrative Hearing and Mediation Rights. Any questions you may have about this matter should be directed to: Arlenc Elliott, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 921-1802, facsimile (850) 410-1972, Sincerely, @. katy D. Kenneth Yon AHCA Administrator aae Enclosure(s) cc: Christopher Parrella, J.D., CHC Health Law Offices of Anthony C. Vitale, P.A. 799 Brickell Plaza Suite 700 Miami, Florida 33131 Medicaid Accounts Receivable Arlene Elliott (Page 4 of 48) Wellsenpts 110 Page suf NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the tight to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Audit Report (hereinafter FAR), you may request a formal administrative hearing pursuant to Section 120.57{L), Florida Statutes. If you do not dispute the facts stated in the FAR, but believe there are additional .feasons to grant the relief you seek, you may request an informal administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section 120.573, Florida Statutes, mediation may be available if you have chosen a formal administrative hearing, as discussed more fully below. The wnitten request for an administrative hearing must conform to the requirements of either Rule 28-106.201(2) or Rule 28-106.301(2), Florida Administrative Code, and must be received by the Assistant Bureau Chief by 5:00 P.M. no later than 21 days after you received the FAR. The address for filing the written request for an administrative hearing is: Assistant Bureau Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 The request must be legible, on 8 % by 11-inch white paper, and contain: 1. Your name, address, telephone number, any Agency identifying number on the FAR, if known, and name, address, and telephone number of your representative, if any; 2. An explanation of how your substantial intcrests will be affected by the action described in the FAR; 3. A statement of when and how you received the F. AR; 4. Fora request for formal hearing, a statement of all disputed issues of material fact; 5. Fora request for formal hearing, a concise statement of the ultimate facts alleged, as well as the rules and statutes which entitle you to Telief; : 6. Fora request for formal hearing, whether you request mediation, if it is available; 7. For a request for informal hearing, what bases support an adjustment to the amount owed to the Agency; and 8. A demand for relief. A formal hearing will be held if there are disputed issues of material fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a neutral third party to assist the parties in a legal or administrative proceeding to reach a settlement of their case. If you and the Agency agree to mediation, it does not mean that you give up the right to a hearing. Rather, you and the Agency will try to settle your case first with mediation. Tf you request mediation, and the Agency agrees to it, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement. If a mediation agreement is not reached within 10 days following the request for mediation, the matter -will proceed without mediation. The mediation must be concluded within 60 days of having entered into the agreement, unless you and the Agency agree to a different time period. The mediation agreement between you and the Agency will include provisions for sclecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shared equally by you and the Agency. (fa written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action sct forth in the FAR shall be conclusive and final. ‘(s)ezis oBeyoed ajqeyene ye pue aava6 pue aweu puelq sapnjour b6'e96'sPe$ *WLOL BL 'E28'SL 98°81$ €20r 6rr'9 0S0'8 zt08°0 tLO'EL SLv'Ol LZ O2S'261$ (eucezueio) sqey Bugg exaidAZ SLEPPLE Sore L022 seg'9 ogs'Z £2180 Zrg'8 06 820'9Z1$ {eudezueo) sqe; Bug, exaidAZ| 9B LAL'P ores bee 0oL's 62990 6822'S 249961 'bS$ (sudezueio) sqey Bug, exaidkz 08 092'2 cL tS StOL O8r'ez 21960 22}€z__|90'Ss0'e9s 3H eurevas) sqe) Bugg! yoioz 09'265'6 rAPaS eer OLZel 0gg'eL 44560 EvS'bl 99 PEZ'POLS piewns audenand) sqe; BUDE Janbosag 9e'9S2'9S orcs 4S€01_ |SZ0'0€ o0g'ze S2z6'0 Zev'or [2+ B68'LZZ$ _frewng oudenano) sei Bwiggz janbolag Se Se'9 Sy et 284'9 oge's 6260 066'9 $8'940'6S$ (euopuadsyy) sqe) Busy epsadsiy 09'2S6'02 ge S$ 6e0'2% 086'22 9960 6r6'0E [42 p8t'9919 (suopuadsiy) sqe} Buz jepradsiy 092966 Ov'rs 6ziz_ [roz'6z —ifoog’ce _—| oes le |zeziz Orig (aozeidesuey) sdeo BWOE poenaig SP 0zb's tL 6$ S6S 2£8'% zZy'e€ [bE SPO'LES Gaevoiny) sdeo BUIQO| JON ¥Z819'8r es pes gor vel ZPS'L GBOS7'ES$ — Jopuadorey) jw/Bwi9g| “9aq jopuedojeH 8b'002'8 LL vt zal bee's esZ'2 79'£S0'2€$ {idH auopiseidiz) sdeo Buigg Uopoad 8p 626'8L Lees g8cSe gsg'ir 26260 2££6'€9 QPL'0S —JOO'PZL'LILS |v xaeudienq) sqey u009 D3 aioxedaq SE€7Z0'7Z £2 4$ Seal S2O'Zb 0f760 78202 OZL'SL fer BZ0'E7$ —_|Nxoodiena) sqey Buiggz 93 ajoyedag 00'r22'6z GO'rLS 0802 zes'y £2860 269'9 z19'9 GLZ16'76$ OO Z'Zb St els 768 Oze'L S960 z9e'% ZbeZ $5 27S Le$ 2 99S'b 80'OL$ esr agz'e '69E6 0 €96'€ Slee $8 sey Le$ aBieyssaag uunpied | eBeyous | saseyoing | paseysing [E30], Adeueyd | presipay | preaipay Aq yyBuajs ; ewey 6nug eyo, aBeiaay |aseysing| payerolg | swup je}o1 | yo yese | Aq-dsiq | fq preg | pied sseyog —___ | i syun jeiol| sun + SHNSEY SISh|eUY ad/OAU| payesolg AVV/d/000-80¢t-90 $002 ‘Of JaqUIaAON - ¥00Z ‘| aquiacagq 008079920 O77 sidysasyay, ON TO [POlag MalAay USQWAN JaplAcig ‘OWEN JapiAoig (gp jo g abed) OZL M3IABY SSIOANT (4 L L + L L b t (4 5 L 1 b t L L b cA z L cf t L (4 (4 z [4 b L L c L t t b L t L L cA L I id L b L L L t Z SVL OWS! AsNiav Savi OWS! AsmMeY S8Vl OWS! ASIIEV SBVL OWS! ASINBV SEVL OWS, ASNIBv Sevl OWSE AsNaVv Savi OWS?) ASINGV SaVl OWSL ASE SEV1L OWSL ASMIGV SVL OWS! AsNAV SaV1l OWS! AsiUSEV Seavl Owst Asay Savi OWS! AsITIAV SVL OWS! AANav SaVL OWS! ASITIAV SEV OWS! AZIeV Savi OWS! Asay S8VL OWS) ASNISV SVL OWS Asay SVL OWS AsIeV SEVi OWS! AANISY SEV OWS) ASIIGV Savi OWst Asniav Savi OWS! AsMeav Savi OWS! Asay SaVL OWS! Asay SAV OWS? ASIIAV SAV OWS! AXNIEV SAV. OWS! AdNav S8V1 OWS! ASITIEV SaVl OWS! AANIEV Savl OWS! Asay SVL SIWNSL Adiav Sv. OWS) AsIEV Sevl OWS! AseV SVL OWSL AMIS sav OWS! AdTmaV sav OWS! Asilav SaVL OWS! ASI Savi OWS! ASIEV Sav. OWS! ASIIaV SVL OWS AJigv SAVL OWS! ASNISV SVL OWS) AFMEV SEV OWS! AdTaVv S8V1 OWS! ASNISV Sevl OWS! ASITIEV Savi OWS! ASNIav Sav1 OWS! Asay av 206082 SLOL02 L8P969 Lesg69 S86189 060E29 06999 ZLEGSS poRsssg bobver9o 6249829 6921429 682b29 89LLZ9 tZ-209 SCELIG cOSOby 289606 b6LS6r6 40L02E SOLOLE bZZ0vE 6PL6ZL 66LbcL 88956 BSbcSr6 tSL6Eb6 8210666 LOvr2e6 vLS6P86 bye 2956 CLBbbS6 SOerhSE E€660ES6 SOEB0ES 90E60E6 6SZE626 4SZE6CE LSLESZE O8Lzezé b8L2ec6 S6LELLE 89rBE06 8E2SZ06 er9SZ06 9r8le6e L6Lp968 6er2cse 2065228 So0e/z1/8 SOOZ/Er8 sooz/ee soocizig SOOZ/L/8 SOOZ/62/L SOOZ/B2/2 soogLese SOOC/L2/L so0z/sere SOOC/S2L S00z/e2ie SO0e¢zzz SOOz/eZeit SOOT EL SDOZ/L EL SOOZ/0E/9 sooze7s SO00Z/Z7/9 Sodz/ee/9 so0z/ez9 s00z/0z/9 SO0Z/L/9 soozse/s Sooz/eers SOOzETz/s SOOC/ELIS SOOZ/OL/S SOOZ Ziv SO0d/Sc/p sodese/e SOOZ/IEZ/E SOOC/ECIE SOOeZz/E gooe/s7e so0d/Se/e S00c/re/e SOO0e¢/P2/e SOC Zz SO0z/ez/z SOOZLLIZ SO0z/v/z SOO0c/22/L So0e/se/t soozeert SOO?/Le/L SOOC/E L/L SOOc/r/L poozecet leurpseg IEUIPIED leulped leulpses jeulprea jeuipses, jeulpleg reulpses jeulpieg IEUIPIED leuipseg leuIpyeg leUIPIeED IEUIPIED leulpses IEUIPJED feulpies on8g oo}1eg leulpse jeuipses jeulpseg reuipies jeulpieg [BUIPIED oo|jag ooi9g reulpies jeulpseg leurpreg feUIpIED reuipreg, jeulpses jeuped FEUIPIED eulpseg jeurpeg jeulpseg eulpseo, jeuipeg eulpled UIPIED eulpleg feuipes, feUlpueD BUIPIeED reUIpIED {EUIDJED leUlpleD leUIpleg OD807289Z0 # JapiAcig O11 SIduOS}aAA fan im tee (Page 7 of 48) Weliscnpts LLC INVOICE REVIEW Provider # 026820800 . Shipp Cardinal 8/15/2005 791058 1 Cardinal 8/25/2005 881593 ABILIFY 15MG TABS 1 30 30 Cardinal 8/25/2005 881597 ABILIFY 1S5MG TABS 2 30 60 Cardinal 8/29/2005 902946 ABILIFY 15MG TABS 1 30 30 Cardinal 8/29/2005 902948 ABILIFY 1SMG TABS 2 30 60 Cardinal 8/29/2005 902956 ABILIFY 15MG TABS 1 30 30 Cardinal 8/30/2005 912207 ABILIFY 15MG TABS 3 30 90 Cardinal 9/12/2005 999712 ABILIFY 15MG TABS 4 30 30 Cardinal 9/12/2005 $99717 ABILIFY 15MG TABS 4 30 30 Cardinal 9/14/2005 1024276 ABILIFY 15MG TABS 1 30 30 Cardinal 9/15/2005 1034422 ABILIFY 15MG TABS 1 30 30 Cardinal 9/26/2005 1108713 ABILIFY 1SMG TABS 1 30 30 Cardinal 9/28/2005 1108714 ABILIFY 15MG TABS 1 30 30 Cardinal 9/27/2005 1124704 ABILIFY 15MG TABS 2 30 60 Cardinal 9/27/2005 1124731 ABILIFY 15MG TABS 1 30 30 Cardinat 9/29/2005 1146258 ABILIFY 15MG TABS 1 30 30 Cardina 9/29/2005 1146262 ABILIFY 15MG TABS 3 30 90 Cardinal 10/5/2005 1192557 ABILIFY 15MG TABS 1 30 30 Cardina 10/10/2005 1217189 ABILIFY 15MG TABS 1 30 30 Cardina 10/14/2005 1257074 ABILIFY 15MG TABS 1 30 30 Cardinal 10/17/2005 1272799 ABILIFY 15MG TABS 1 30 30 Cardinal 10/19/2005 1298947 ABILIFY 15MG TABS 1 30. 30 Cardinal 10/27/2005 1353780 ABILIFY 15MG TABS 3 30 90 Cardinal 10/27/2005 1353777 ABILIFY 15MG TABS 4 30 30 Cardina 10/31/2005 1370709 ABILIFY 15MG TABS 2 30 60 Cardinal 10/31/2005 1370806 ABILIFY 15MG TABS 2 30 60 Cardinal 14/2/2005 1398925 ABILIFY 15MG TABS 1 30 30 Cardinal 11/11/2005 1480110 ABILIFY 15MG TABS 1 30 30 Cardinal 11/18/2005 1538685 ABILIFY 15MG TABS 1 30 30 Cardinal 11/22/2005 1556873 ABILIFY 15MG TABS 1 30 30 Cardinal 11/22/2005 1556878 ABILIFY 15SMG TABS 2 30 60 Cardinal 11/23/2005 1573553 ABILIFY 15MG TABS 3 30 90 Cardinal 11/25/2005 1584639 ABILIFY 15MG TABS 1 30 30 Cardinal 11/28/2005 1596696 ABILIFY 15MG TABS 3 30 90 116 3480 Cardinal 12/1/2004 8554332 ABILIFY 20MG TABS 2 30 60 Cardinal 1/19/2005 8964791 ABILIFY 20MG TABS 2 30 60 Cardinal 4/5/2005 9660446 ABILIFY 20MG TABS 1 30 30 Cardinal 4/8/2005 9701773 ABILIFY 20MG TABS 1 30 30 Cardinal 4/15/2005 9769768 ABILIFY 20MG TABS 1 30 30 Cardinat 4/22/2005 9834433 ABILIFY 20MG TABS 4 30 30 Cardinal 4/28/2005 9886981 ABILIFY 20MG TABS 1 30 30 Bellco §/3/2005 9424853 ABILIFY 20MG TABS 2 30 60 Belico §/13/2005 9439751 ABILIFY 20MG TABS 2 30 60 Cardinal 6/6/2005 214635 ABILIFY 20MG TABS 1 30 30 Cardinal 7/6I2005 = 480967 ABILIFY 20MG TABS 4 30 30 Cardinal 7/20/2005 596573 ABILIFY 20MG TABS 1 30 30 Cardinal 7/27/2005 = 655812 ABILIFY ZOMG TABS 1 30 30 Cardinal 7/28/2005 666494 ABILIFY 20MG TABS 1 30 30 (Page 8 of 48) Wellseripts LLC INVOICE REVIEW Prowider # 026820800 ABILIFY 20MG TABS Cardinai 4 Cardinal 8/3/2005 707078 = ABILIFY 20MG TABS 1 Cardinal 8/4/2005 716272 ABILIFY 20MG TABS 2 Cardinal 8/5/2005 727080 ABILIFY 20MG TABS 1 Cardinal 8/9/2005 752202 ABILIFY 20MG TABS 1 Cardinal 8/18/2005 823986 ABILIFY 20MG TABS 1 Cardinal 8/18/2005 823979 ABILIFY 20MG TABS 1 Cardinal 8/19/2005 837948 ABILIFY 20MG TABS 1 Cardinal 8/24/2005 869158 ABILIFY 20MG TABS 1 Cardinal 8/29/2005 902946 ABILIFY 20MG TABS 1 Cardinal 8/29/2005 902957 ABILIFY 20MG TABS 1 Cardinal 9/7/2005 968721 ABILIFY 20MG TABS 4 Cardinal 9/19/2005 1054543 ABILIFY 20MG TABS 4 Cardinal 9/20/2005 1067199 ABILIFY 20MG TABS 1 Cardinal 9/29/2005 1146260 ABILIFY 20MG TABS 2 Cardinal 10/6/2005 1202484 ABILIFY 20MG TABS 3 Cardinal 10/18/2005 1287251 ABILIFY 20MG TABS 1 Cardinal 10/20/2005 1311217 ABILIFY 20MG TABS 1 Cardinal 10/27/2005 1353780 ABILIFY 20MG TABS 1 Cardinal 11/7/2005 1437858 ABILIFY 20MG TABS 2 Cardinal 41/47/2005 1524077 ABILIFY 20MG TABS 1 47 1410 Cardinal 12/2/2004 8562529 ABILIFY 30MG TABS 2 30 60 Cardinal 12/15/2004 8675501 ABILIFY 30MG TABS 1 30 30 Cardina 12/17/2004 8698886 ABILIFY 30MG TABS 2 30 60 Cardinal 12/20/2004 8710356 ABILIFY 30MG TABS 1 30 30 Cardina 12/21/2004 8724586 ABILIFY 30MG TABS 1 30 30 Cardinal 12/21/2004 8724595 ABILIFY 30MG TABS 1 30 30 Cardina 12/23/2004 8747265 ABILIFY 30MG TABS 2 30 60 Cardina 12/28/2004 8775907 ABILIFY 30MG TABS 1 30 30 Cardinal 1/3/2005 8812583 ABILIFY 30MG TABS 4 30 30 Cardinal 1/4/2005 8827487 ABILIFY 30MG TABS 1 30 30 Cardinal 1/11/2005 8892068 ABILIFY 30MG TABS 2 30 60 Cardina 18/2005 8956215 ABILIFY 30MG TABS 1 30 30 Cardina. 1/18/2005 8986222 ABILIFY 30MG TABS 2 30 60 Cardinal 1/19/2005 8964791 ABILIFY 30MG TABS 2 30 60 Cardinal 1/20/2005 8976487 ABILIFY 30MG TABS 1 30 30 Cardinal 1/20/2005 8976494 ABILIFY 30MG TABS 1 30 30 Cardinal 1/26/2005 9025642 ABILIFY 30MG TABS 1 30 30 Cardinal 1/26/2005 9025744 ABILIFY 30MG TABS 4 30 30 Cardinal 1/26/2005 9025739 ABILIFY 30MG TABS 4 30 30 Cardinal 2/1/2005 9079101 ABILIFY 30MG TABS 1 30 30 Cardinal 2/8/2005 9138551 ABILIFY 30MG TABS 3 30 90 Cardinai 2/9/2006 9152356 ABILIFY 30MG TABS 4 30 30 Cardinal 2/11/2005 9177628 ABILIFY 30MG TABS 1 30 30 Cardinal 2/18/2005 9240012 ABILIFY 30MG TABS 1 30 30 Cardinal 2/21/2005 9250274 ABILIFY 30MG TABS 1 30 30 Cardinai 2/24/2005 9293161 ABILIFY 30MG TABS 2 30 60 Cardinal 2/24/2008 9293259 ABILIFY 30MG TABS 4 30 30 (Page 9 of 48) Weilscripts LLC INVOICE REVIEW Provider # 026820800 ‘ oem nae
