19-002882F Agency For Health Care Administration vs. Hcr Manor Care Services Of Florida, Llc, D/B/A Heartland Home Health Care Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, September 11, 2019.

AGEKY CLERK

STATE OF FLORIDA 2119 OCT 2 9 P 1: 5 1

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, DOAH Case No.: 19- 2882F

DCA Case No.: 1D19- 1857

VS. PROVIDER No.: 000141800

NPI No.: 1275666273

LICENSE No.: 50370971

MPI Case No.: 2016- 0006546

HCR MANOR CARE SERVICES OF RENDITION NO.: AHCA- ' " 1 - '`' - S- MDO

FLORIDA, LLC., d/ b/ a HEARTLAND

HOME HEALTH CARE AND HOSPICE,

Respondent.

FINAL ORDER

THIS CAUSE comes before the AGENCY FOR HEALTH CARE ADMINISTRATION

the " Agency") concerning a Final Audit Report ( the " FAR") dated August 14, 2017. The FAR

concluded there was an overpayment from HCR Manor Care Services of Florida, LLC, d/ b/ a

Heartland Home Health Care ( the " Provider") in the amount of $ 127, 015. 43, plus sanctions of

25, 403. 09. Costs were assessed at $ 75. 55 for a total amount due of $ 152, 494. 07.

Thereafter, the Provider filed a Petition for Formal Administrative Hearing with respect to

the FAR, which was forwarded by the Agency Clerk at the Division of Administrative Hearings

DOAH") and a hearing was held. Over time, the Provider paid the amount of $ 127, 015. 43 to

the Agency. The Administrative Law Judge (" ALJ") found that the Agency was entitled to recover

an overpayment of $ 58, 468. 22 plus a fine of $ 11, 693. 64. The ALJ further found that the Agency

prevailed regarding two or the three claims and was therefore entitled to investigative, legal, and

expert witness costs. The Agency issued its Final Order on April 19, 2019.

The Provider timely filed a Notice of Appeal of the Final Order with the First District Court

of Appeal in Case No. 1D19-1857. After the parties did not reach an agreement on the amount of

costs, the Agency timely filed a Petition for Recovery of Petitioner's Fees and Costs with DOAH,

which became Case No. 19-2882F.

The parties then resolved all issues and executed the attached Settlement Agreement. In

accordance with the settlement agreement, on September 10, 2019, the Agency filed its Notice of

Voluntary Dismissal of the DOAH case. On September 11, 2019, an Order Closing Case and

Relinquishing Jurisdiction was issued by DOAH as a result of the Notice of Voluntary Dismissal.

On October 16,2019, the Provider filed its Notice ofSett1ement and Stipulation for Dismissal with

the appellate court. The appellate court entered its order dismissing the appeal in Case No. 1D19-

1857 on October 17,2019.

It is therefore ORDERED and ADJUDGED:

1. The parties have complied with the terms of the settlement agreement.

3. The above-styled case is closed.

DONE and ORDERED this day of , 2019, in Tallahassee,

Leon County, Florida.

HEW, SECRETARY

for Health Care Administration

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

TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY

OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND

COPY ALONG WITH FILING FEE AS PRESCRIBED BYLAW, 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:

Brittany Adams Long, Esquire Steven A. Grigas, Esquire

RADEY LAW FIRM Bruce D. Platt, Esquire

301 S. Bronough Street, Suite 200 AKERMANLLP

Tallahassee, Florida 32301 106 East College A venue

balong@radeylaw .com Tallahassee, Florida 32301

(Electronic mail) [e-mail]

[e-mail]

(Electronic mail)

Kelly Bennett, Chief, MPI

(Electronic mail) Bryan Nowicki, Esquire

Joshua Taggatz, Esquire

Bureau of Financial Services REINHART, BOERNER VAN DEUREN

(Electronic mail) 22 East Mifflin Street

Madison, WI 53701

Joseph G. Hem, Jr., Esquire bnowicki(U)reinhartlaw .com

Kimberly Murray, Esquire jtaggatz@reinhartlaw .com

Thomas Hoeler, Esquire (Electronic mail)

Office of General Counsel

(Electronic mail) Shena L. Grantham

MAL & MPI Chief Counsel

Stefan R. Grow, General Counsel (Electronic mail)

(Electronic mail)

Division of Health Quality Assurance J. Nixon Daniel, III, Esquire

Health Facility Regulation Terrie L. Didier

[e-mail] BEGGS & LANE, RLLP

(Electronic mail) 501 Commendencia Street

Pensacola, Florida 32502

Division ofHealth Quality Assurance jnd(il{beggslane.com

Bureau of Central Services [e-mail]

[e-mail] (Electronic mail)

(Electronic mail)

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 or other designated method on this

,2019.

R1c a . hoop, Esquire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

[phone]/F AX [phone]

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, DOAH Case No. 19-2882F

DCA Case No. 1 D 19-1857

v.

MPI Case No.: 20 16-0006546

HCR MANOR CARE SERVICES OF PROVIDER ID No.: 000141800

FLORIDA, LLC, D/B/A HEARTLAND NPI No.: 1275666273

HOME HEALTH CARE AND HOSPICE, LICENSE No.: 50370971

Respondent.

--------······-··------···----- I

SETTLEMENT AGREEMENT

Petitioner, the STATE OF FLORIDA, AGENCY FOR HEALTH CARE

ADMINISTRATION ("AHCA'' or "Agency"), and Respondent, HCR MANOR CARE

SERVICES OF FLORIDA, LLC, D/8/A HEARTLAND HOME HEALTH CARE AND

HOSPICE ("PROVIDER"), by and through the undersigned, hereby stipulate and agree as

follows:

I. The parties enter into this settlement agreement ("Agreement") for the purpose

of memorializing the resolution of this matter.

2. PROVIDER is a Medicaid provider in the State of Florida, provider number

000141800, and was a provider during the audit period.

3. In its Final Audit Report, sent by certified mail to the PROVIDER on August

14, 201 7, the Agency notified PROVIDER that a review of Medicaid claims performed by

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Horne

Health Care and Hospice

(MPI Case No.: 20 16-0006546)

Settlement Agreement

Page I of7

Health Integrity, LLC (now, Qlarant Quality Solutions, LLC) and the Agency's

Office of the Inspector General, Medicaid Program Integrity ("MPI"), during the period of July

I, 2011, through December 31, 2014, indicated that claims related to three recipients, in whole

or in part, were inappropriately paid by Medicaid. The Agency sought repayment of this

overpayment, in the amount of one hundred twenty-seven thousand, fifteen dollars and forty-

three cents ($127,015.43). Additionally, the Agency applied sanctions in accordance with

sections 409.913(15), (16), and (17), Florida Statutes, and Rule 590-9.070(7), Florida

Administrative Code. Specifically, the Agency assessed the following sanctions against

PROVIDER: a fine in the amount oftwenty-five thousand, four hundred and three dollars and

nine cents ($25,403.09) pursuant to Rule 59G-9.070(7)(e), Florida Administrative Code; and

costs in the amount of seventy-five dollars and fifty-five cents ($75.55) pursuant to section

409.913(23)(a), Florida Statutes. The total amount due was one hundred fifty-two thousand,

four hundred ninety-four dollars and seven cents ($152,494.07).

4. In response to the Final Audit Report, PROVIDER filed a Petition for Formal

Administrative Hearing (the "Petition"). Over time, PROVIDER also paid the amount of

$127,015.43 to AHCA through recoupments.

5. The Agency referred the Petition to the Division of Administrative Hearings

("DOAH") and a hearing was held in Case No. 1 8-1848MPI. The Administrative Law Judge

("ALJ") found that AHCA was entitled to recover an overpayment for hospice services for two

of the three patients in the amount of fifty-eight thousand, four hundred and sixty eight dollars

and twenty-two cents ($58,468.22). The ALJ found that the appropriate fine was eleven

thousand, six hundred and ninety-three dollars and sixty- four cents ($11 ,693.64 ). The ALJ further

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Home

Health Care and Hospice

(MPI Case No.: 2016-0006546)

Settlement Agreement

Page 2 of7

found that AHCA prevailed regarding two of the three claims and ordered AHCA to provide

evidence of its investigative, legal, and expert witness costs incurred in the proceeding in

accordance with section 409.913(23), Florida Statutes. PROVIDER was given an opportunity to

contest AHCA's claim.

6. The Agency issued its Final Order on April 19, 2019. In the Final Order, the Agency

adopted the ALl's conclusions of law and findings of fact, except where noted. The Agency

explained that the PROVIDER owed the Agency $58,468.22 in overpayments for services

provided to Medicaid recipients and imposed a fine of $11,693.65. The Agency noted that

because PROVIDER had already paid the Agency $127,015.43 (the total amount listed in the

Final Audit Report), PROVIDER was entitled to a refund of fifty-six thousand, eight hundred

and fifty-three dollars and fifty-seven cents ($56,853.57) ($127,0 15.43 - $58,468.22- $11,693.64

= $56,853.57). In addition, the Final Order found that because the Agency prevailed in this

matter, it was entitled to recover the investigative, legal, and expert witness costs it incurred in

the matter. The Agency ordered that if the parties were unable to reach agreement of the amount,

either party could file a request for a hearing with the ALJ who presided over the matter within

30 days of rendition of the Final Order.

7. PROVIDER timely tiled a Notice of Appeal ofthe Final Order with the First District

Court of Appeal in Case No. 1 D 19-185 7. After the parties did not reach agreement on the amount

of costs, the Agency timely filed a Petition of Recovery of Petitioner's Fees and Costs with

DOAH, which became Case No. 19-2882F.

8. ln order to amicably resolve this matter without further administrative or appellate

proceedings, PROVIDER and AHCA agree as follows:

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Home

Health Care and Hospice

(MPI Case No.: 2016-0006546)

Settlement Agreement

Page 3 of7

(I) AHCA agrees to voluntarily dismiss its Petition for

Recovery of Fees and Costs in case number 19-2882P.

Dismissal will be final upon execution of the Final Order in this case.

(2) PROVIDER agrees to voluntarily dismiss its Notice of Appeal

in case number ID19-1857 within 5 days ofthe issuance ofthe Final

Order issued in this case.

(3) PROVIDER and AHCA agree that the payments described above,

including the refund to PROVIDER, resolve and settle this case

completely and release both parties from any administrative or civil

liabilities arising from the findings relating to the claims determined to

have been overpaid as referenced in audit MPI Case Number 2016-

0006546.

(4) PROVIDER agrees that it shall not re-bill the Medicaid

Program in any manner for claims that were not covered by Medicaid,

which are the subject of the review in this case.

9. The parties reserve the right to enforce this Agreement under the laws of the State of

Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations.

10. This settlement does not constitute an admission of wrongdoing or error by either

party with respect to this case or any other matter.

11. The signatories to this Agreement, acting in a representative capacity, represent that

they are duly authorized to enter into this Agreement on behalf of the respective parties.

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Home

Health Care and Hospice

(MPI Case No.: 2016-0006546)

Settlement Agreement

Page 4 of7

12. This Agreement shall be construed in accordance with the provisions of the laws of

Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida.

13. This Agreement constitutes the entire agreement between PROVIDER and AHCA,

including anyone acting for, associated with, or employed by the parties, concerning this matter

and supersedes any prior discussions, agreements, or understandings. There are no promises,

representations, or agreements between PROVIDER and AHCA other than as set forth herein. No

modification or waiver of any provision shall be valid unless a written amendment to the

Agreement is completed and properly executed by the parties.

14. This is an Agreement of Settlement and Compromise, made in recognition that the

parties may have different or incorrect understandings, information, and contentions as to facts

and law, and with each party compromising and settling any potential correctness or incorrectness

of its understandings, information, and contentions as to facts and law, so that no misunderstanding

or misinformation shall be a ground for rescission hereof.

15. PROVIDER expressly waives in this matter its right to any hearing pursuant to

sections 120.569 or 120.57, Florida Statutes; the making of findings of fact and conclusions oflaw

by the Agency; all further and other proceedings to which it may be entitled by law or rules of the

Agency regarding this proceeding; and any and all issues raised herein. PROVIDER further agrees

that it shall not challenge or contest any Final Order entered in this matter which is consistent with

the terms of this Settlement Agreement in any forum now or in the future available to it, including

the right to any administrative proceeding, circuit or federal court action, or any appeal.

16. The parties agree to bear their own attorney's fees and costs related to the current

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Home

Health Care and Hospice

(MPI Case No.: 2016-0006546)

Settlement Agreement

Page 5 of7

matters.

17. This Agreement is and shall be deemed jointly drafted and written by all parties to it

and shall not be construed or interpreted against the party originating or preparing it.

18. To the extent that any provision of this Agreement is prohibited by law for any

reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall

not affect any other provision of this Agreement.

19. This Agreement shall inure to the benefit of and be binding on each party's successors,

assigns, heirs, administrators, representatives, and trustees.

20. All times stated herein are of the essence of this Agreement.

21. This Agreement shall be in full force and effect upon execution by the respective

parties in counterpart.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK

Agency for Health Care Administration v. HCR Manor Care Services of Florida, LLC, d/b/a Heartland Home

Health Care and Hospice

(MPI Case No.: 2016-0006546)

Settlement Agreement

Page 6 of?

10/Sep/2019 08:44:14 t-ltartland 912-261-8931 , /1

Dated: ¥ I 0 • 2019

BY

(Print Name and Title)

AGENCY FOR HEALTH CARE ADMINISTRATION

2727 Mahan Drive. Bldg. 3, Mail Stop *3

32308-5403

Dated: fo{,, • 2019

Mol

Dated: tdf .2019

Dated: l t:J I L I • 2019

Dated: S,p pt. \\ L , 2019

Aacncy for Health C.are Admlniltratlon v, HCR Manor Care Services of Florida, LLC, cllbl• Hoanland Home

Health Care and Hospice

(Ml'l Cue No.: 20Ul-0006546)

Apment

Pqe7of7