11-006339MPI Agency For Health Care Administration vs. Jumerolis Home Care, Corp. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, February 6, 2012.

STATE OF FLORIDA FIL"ED r.\\-WA

AGENCY FOR HEALTH CARE ADMINISTRATION A.GENCl C'lERr\\

STATE OF FLORIDA, AGENCY FOR 1011 APR 20 A 8: lllt

HEALTH CARE ADMINISTRATION,

Petitioner, Case No. 11-6339MPI

Provider No. 142533100

vs. C.I. No. 12-0804-000

JUMEROLIS HOME CARE, CORP.,

Respondent.

----------------_./

FINAL ORDER

This cause came before me for issuance of a Final Order. In a sanction letter dated

November 9, 2011, Respondent, Jumerolis Home Care Corp. was informed the Agency was

seeking to impose a fine in the amount of eight thousand dollars ($8,000.00). The letter was sent

certified mail, return receipt requested to Jumerolis Home Care Corp. (hereinafter

"PROVIDER").

The letter contained full disclosure and notice regarding the PROVIDER'S administrative

hearing and due process rights. The PROVIDER filed a petition for hearing. Upon review of

documents subsequently submitted by the PROVIDER to the Agency, it was determined the

sanction should be recalculated and the fine was adjusted to one thousand dollars ($1,000.00). A

copy of the correspondence reflecting the recalculated fine is attached hereto and incorporated by

reference herein.

The PROVIDER paid the fine of $1,000.00 to the Agency's Finance and Accounting

Department on February 21,2012. Copies of the check(s) and final agency action report(s) are

also incorporated by reference herein. The PROVIDER withdrew the Petition.

AHCA v Jumerolis Home Care Corp.

Page I of3

Filed April 20, 2012 9:54 AM Division of Administrative Hearings

The PROVIDER paid the fine of $1,000.00 to the Agency's Finance and Accounting

Department on February 21, 2012. Copies of the check( s) and final agency action report( s) are

also incorporated by reference herein. The PROVIDER withdrew the Petition.

Based on the foregoing, the sanction has beenpaid and the file is CLOSED.

DONE AND ORDERED this of April, 2012, in Tallahassee, Florida .

•

Agency for Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED

TO A JUDICIAL REVIEWWHICH 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:

Allan Cao Beverly H. Smith, Esquire

Jumerolis Home Care Corp. Assistant General Counsel

956 Southwest 143 Place Agency for Health Care Administration

Miami, Florida 33184 2727 Mahan Drive, MS #3

(U.S. Mail) Tallahassee, Florida 32308

(Interoffice Mail)

Claude B. Arrington Mike Blackburn, Bureau Chief, Medicaid

Administrative Law Judge Program Integrity

Division of Administrative Hearings (Interoffice Mail)

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(U.S. Mail)

Finance and Accounting Health Quality Assurance

AHCA v Jumerolis Home Care Corp.

Page 2 of3

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished

to the above named addresses by U.S. Mail on this the -zh y of April, 2012.

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

(850) 412- 3630/FAX [phone]

AHCA v Jumerolis Home Care Corp.

Page 3 of3

JwcA flORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

RICK SCOTT Better Health Care for all Floridians ELIZABETH DUDEK

GOVERNOR SECRETARY

CERTIFIED MAIL RETURN RECEIPT NO.

January 17,2012

c.1. No: 120804000

Provider No: 142533100 Provider License No: 9687

Jumerolis Home rd Care Corporation

956 SW 143 Place

Miami, Florida, 33184

In Reply Refer to: Sanction

Dear Provider:

In accordance with Section 409.913, Florida Statutes (F.S.), and Rule 590-9.070, Florida

Administrative Code (F.A.C.), the Agency for Health CareAdministration (Agency), shall apply

sanctions for violations of federal and state laws, including the following violation of Medicaid

policy:

• Failure to maintain a current Health Assessment and Service plan in one recipient record.

This letter shall serve as notice ofthe following sanction(s):

•A fine of$1000.00 for violation(s) of7(e) under Rule Section 590-9.070, F.A.C.

Furthermore, this letter serves as notice that the agency, upon entry of a final agency order, a

judgment or order of a court of competent jurisdiction, or a stipulation or settlement, may collect

the moneys owed by all means allowable by law, including, but not limited to, notifying any

fiscal intermediary of Medicare benefits that the state has a superior right of payment. Upon

receipt of such written notification, the Medicare fiscal intermediary shall remit to the state the

sum claimed. This is in accordance with Section 409.913, (25) (d) F.S.

Please remit a certified check in the amount of$1000.00. 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, [phone]. To

ensure proper credit, be certain yourprovider number and the investigation case number

(120804000) are shown on your check. Please mail payment to:

Medicaid Accounts Receivable - MS # 14

Agency for Health Care Administration

2727 Mahan Drive Bldg. 2, Ste. 200

Tallahassee, FL 32308

2727 Mahan Drive, MS# 6 Visit AHCA online at

Tallahassee, Florida 32308 http://ahca.myflorid a. com

Jumerolis Home Care Corporation

142533100

File 78604 or Case 120804000

January 17,2012

Page 2 of 4

If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency

may withhold Medicaid payments or impose additional sanctions, which include, but are not

limited to, fines, suspension and termination from the Medicaid Program.

You have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. If a

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. If a 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: Heberto A. Blandino,

Inspector; Agency for Health Care Administration, Medicaid Program Integrity, P.O. Box

52-2804, Miami, Florida 33152-2804, telephone [phone], facsimile [phone].

Sincerely,

Horace Dozier

Field Office Manager

Office of Inspector General

Medicaid Program Integrity

Enclosures

cc: AHCA Bureau of Finance and Accounting

Attn: Katrina Derico-Harris

Health Quality Assurance (HQA)

(Ex.1)

Jumerolis Home Care Corporation

142533100

File 78604 or Case 120804000

January 17,2012

Page 3 of 4

NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS

You have the right 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(1), Florida Statutes.

If you do not dispute the facts stated in the FAR, but believe there are additional reasons 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 written 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 Agency

for Health Care Administration, 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:

Richard J. Shoop, Esquire

Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

Fax: [phone]

The request must be legible, on 8 lh by II-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 yoursubstantial interests will be affected by the action described in the

FAR;

3. A statement of when and how you received the FAR;

4. For a request for formal hearing, a statement of all disputed issues of material fact;

5. For a request for formal hearing, a concise statement of the ultimate facts alleged, as well as the

rules and statutes which entitle you to relief;

6. For a request for formal hearing, whether you request mediation, if it is available;

7. For a request for informal hearing, what bases support an adjustmentto 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.

If you request mediation, and the Agency agreesto 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 selecting 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.

If a written request for an administrative hearing is not timelyreceived you will have waived your

right to havethe intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set

forth in the FAR shall be conclusive and final.

Jumerolis Home Care Corporation

142533100

File 78604 or Case 120804000

January 17,2012

Page 4 of 4

Complete this form and send along with your check to:

Agency for Health Care Administration

Medicaid Accounts Receivable

2727 Mahan Drive, Mail Stop #14

Tallahassee, Florida 32308

CHECK MUST BE MADE PAY ABLE TO: FLORIDA AGENCY FOR HEALTH CARE

ADMINISTRATION

Provider Name: Jumerolis Home Care

Provider ID: 142533100

MPI Case #: 120804000

Overpayment Amount:

Fine Amount: $1000.00

Total Amount Owed: $1000.00

Check Number:

Untitled Document Page 1 of 1

Payments

Balance

MAR Number: 14865

Balance per F/A: $0.00

Balance Last Updated: 03/07/2012

Paid in Full:

Repayment Status: LEGAL - UNDER APPEAL - DOAH

Transactions

Trans Type Date Total Trans Amount alP Fine Interest Misc

BILLED 02/21/2012 $1,000.01 $0.01 $1,000.00 $0.00 $0.00

BILL ADJUSTMENT 02/21/2012 ($0.01) ($0.01) $0.00 $0.00 $0.00

COLLECTED 02/21/2012 ($1,000.00) $0.00 ($1,000.00) $0.00 $0.00

Balance: $0.00 $0.00 $0.00 $0.00 $0.00

Disclaimer: This balance should not be used to quote amount due by provider. Only FI A can verify

amounts for this purpose.

©1994 Infinity Software Development, Inc. User Documentation

http://ahcanet/facts/payments _mar. asp 03/07/2012