02-004174MPI Arthur Henson, D.O. vs. Agency For Health Care Administration Status: Closed Recommended Order on Thursday, June 29, 2006.

Summary: Respondent demonstrated that Petitioner received overpayments in the Medicaid program and should repay the overpayment amount.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

ARTHUR HENSON, D.O., )

)

Petitioner, )

)

vs. ) Case No. 02 - 4174MPI

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

________________________________)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was held in this case

by video teleconference on June 6, 2005, with connecting sites

in Miami and Tallahassee, Florida, before Errol H. Powell, a

designated Administrative Law Judge of the Division of

Administrative Hearings.

APPEARANCES

For Petitioner: Kevin J. Kulik, Esquire

Kevin J. Kulik, P.A.

600 South Andrews Avenue, Suite 500

Fort Lauderdale, Florida 33301

For Respondent: Anthony L. Conticello, Esquire

Agency for Health Care Administ ration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

STATEMENT OF THE ISSUE

The issue for determination is whether Petitioner was

overpaid by the Medicaid program as indicated in Respondent's

Final Agency Audit Report dated June 20, 2001.

PRELIMINARY STATEMENT

By Final Agency Audit Report (FAAR) dated June 20, 2001,

Arthur Henson, D.O., was notified by the Agency for Health Care

Administration (AHCA) that a review of his Medicaid claims for

the period Janua ry 1, 1998 through September 30, 2000, indicated

that he had been overpaid by the Medicaid program in the amount

of $124,556.83. The procedure and formula for the calculation

of the overpayment was included in the FAAR. Dr. Henson,

through counsel, dispu ted the FAAR and requested a hearing. On

October 25, 2002, this matter was referred to the Division of

Administrative Hearings.

The hearing in this matter was scheduled for a four - day

hearing commencing January 28 through 31, 2003. Discovery

proceeded an d, subsequently, Dr. Henson requested the

notification of absent parties (the medical center with which he

was employed and the officer and shareholder of the medical

center) to allow them an opportunity to become parties in this

proceeding; the request wa s granted. As a result, the hearing

was continued and, after consultation with the parties, the

hearing was rescheduled for June 3 through 6, 2003. On March 6,

2003, Dr. Henson's counsel filed an Emergency Motion to Withdraw

and Motion for Continuance. The Emergency Motion to Withdraw

was granted , and Dr. Henson was provided an opportunity to

obtain new counsel; but the Emergency Motion for Continuance was

denied as the undersigned was not persuaded that new counsel

could not prepare for the hearing give n the length of time

before the hearing was to commence. Dr. Henson kept the

undersigned advised as to his progress on obtaining new counsel.

On May 6, 2003, AHCA requested and was granted a continuance of

the hearing, and the hearing was re - scheduled fo r July 28

through 31, 2003. On July 8, 2003, a Notice of Appearance was

filed by Dr. Henson's new counsel. Subsequently, the Notice of

Hearing was amended twice: firstly, reflecting an amended

hearing date of September 24 through 26, 2003; and secondly,

reflecting an amended hearing date of October 28 through 30,

2003. Afterwards on October 22, 2003, counsel for Dr. Henson

requested a continuance based primarily upon various pending

discovery matters, exhibits, a crucial witness, and prior

counsel matter s, which was granted.

By Order to Show Cause dated December 17, 2003, the parties

were directed to show cause why the file in the instant matter

should not be closed. The parties successfully demonstrated

that the file should not be closed. The hearing w as re -

scheduled for April 21 through 23, 2004. On April 8, 2004,

Dr. Henson's counsel of record filed for leave to withdraw and

for a continuance of the hearing. Dr. Henson's counsel was

permitted to withdraw, Dr. Henson was allowed an opportunity to

obt ain counsel again, and a continuance was granted. Dr. Henson

kept the undersigned advised as to his ability to obtain

counsel.

On July 14, 2004, a Notice of Appearance was filed by

counsel for Dr. Henson. After consultation with the parties,

the hearin g was re - scheduled for February 23 through 25, 2005.

Discovery continued. Subsequently, Dr. Henson's counsel

requested a continuance, which was granted, and the hearing was

re - scheduled for April 26, 28, and 29, 2005. Afterwards,

Dr. Henson's counsel re quested the hearing to be held by video

teleconference due to Dr. Henson's financial constraints. Video

teleconferencing was unavailable for the scheduled hearing

dates. On April 19, 2005, the parties filed a Joint Motion to

Reset Final Hearing, so that the hearing could be held by video

teleconference. The joint motion was granted and the hearing

was re - scheduled by video teleconference on June 6 and 7, 2005.

AHCA filed a unilateral pre - hearing statement.

At hearing, the parties agreed that AHCA had th e burden of

proof. AHCA presented the testimony of one witness and entered

30 exhibits (Respondent's Exhibits numbered 1 - 29 and 31) into

evidence, with two exhibits (Respondent's Exhibits 4 and 29)

being video depositions. Dr. Henson testified in his own behalf

and entered no exhibits into evidence. A transcript of the

hearing was ordered. At the request of the parties, the time

for filing post - hearing submissions was set for more than ten

days following the filing of the transcript. After a

considerab le amount of time had elapsed from the date of the

hearing, the undersigned requested a status on the transcript

from the parties. AHCA responded and obtained the transcript of

the hearing. The Transcript, consisting of one volume, was

filed on December 30, 2005. An extension of time was requested

for the filing of post - hearing submissions , which was granted.

AHCA filed its post - hearing submission on February 17,

2006, and Dr. Henson filed his post - hearing submission on

February 27, 2006. The parties ’ p ost - hearing submissions were

considered in the preparation of this Recommended Order.

FINDINGS OF FACT

1. Dr. Henson was an authorized Medicaid provider during

the audit period of January 1, 1998 through September 30, 2000. 1

2. During the audit period, D r. Henson had been issued

Medicaid provider number 0467243 - 00. 2

3. No dispute exists that, during the audit period,

Dr. Henson had a valid Medicaid Provider A greement(s) with AHCA. 3

4. During the audit period, Dr. Henson was employed by

Latin Quarter Me dical Center, located at 855 Southwest 8th

Street, Miami, Florida, at which he treated Medicaid recipients.

5. Dr. Henson had been a surgeon but had suffered a stroke

in December 1997 , which caused him to be incapable of continuing

to practice as a surgeo n. He agreed to become employed with

Latin Quarter Medical Center to work at its new clinic and to

receive compensation for his services every two weeks. Latin

Quarter Medical Center's patients were suffering from AIDS.

6. Dr. Henson agreed to several t erms and conditions in

executing a Medicaid Provider Agreement (Agreement) with AHCA.

Those terms and conditions included the following:

(2) Quality of Service . The provider

agrees to provide medically necessary

services or goods . . . agrees that servi ces

and goods billed to the Medicaid program

must be medically necessary . . . The

services and goods must have been actually

provided to eligible Medicaid recipients by

the provider prior to submitting the claim.

(3) Compliance . The provider agrees to

comply with all local, state and federal

laws, rules, regulation, licensure laws,

Medicaid bulletins, manuals, handbooks and

Statements of Policy as they may be amended

from time to time.

(4) Term and signatures . . . . This

provider agreement . . . shal l remain in

effect until July 1, 1999, unless otherwise

terminated. . . .

(5) Provider Responsibilities . The Medical

provider shall:

* * *

(b) Keep and maintain . . . all medical and

Medicaid related records as the Agency may

require and as it de termines necessary; make

available for state and federal audits for

five years, complete and accurate

medical . . . records that fully justify and

disclose the extent of the goods and

services rendered and billings made under

the Medicaid. . . .

The Agre ement was signed by Dr. Henson in 1996.

7. In a Noninstitutional Professional and Technical

Medicaid Provider Agreement, Dr. Henson agreed to terms and

conditions including the following:

2. The provider agrees to keep complete and

accurate medical . . . records that fully

justify and disclose the extent of the

services rendered and billings made under

the Medicaid program . . . .

3. The provider agrees that services or

goods billed to the Medicaid program must be

medically necessary . . . and the servi ces

and goods must have been actually provided

to eligible Medicaid recipients by the

provider prior to submitting a claim. The

provider agrees to submit Medicaid claims in

accordance with program policies and that

payment by the program for services rend ered

will be based on the payment methodology in

the applicable Florida Administrative

Rule. . . .

* * *

8. The provider and the Department

[Department of Health and Rehabilitative

Services] agree to abide by the provisions

of the Florida Administr ative Code, Florida

Statutes, policies, procedures, manuals of

the Florida Medicaid Program and Federal

laws and regulations.

The Agreement was signed by Dr. Henson in 1988.

8. AHCA audited certain of Dr. Henson's Medicaid claims

pertaining to services r endered between January 1, 1998 and

September 30, 2000.

9. By Preliminary Agency Audit Report (PAAR) dated

April 12, 2001, AHCA notified Dr. Henson that, after a physician

consultant with a specialty in infectious disease reviewed the

Medical claims and m edical records provided by Dr. Henson, a

preliminary determination was made that certain claims in the

amount of $124,556.83 were not covered by Medicaid.

10. After the issuance of the PAAR, no further

documentation was submitted by Dr. Henson to AHCA. A s a result,

AHCA issued a FAAR dated June 20, 2001, upholding the

overpayment of $124,556.83. The FAAR indicated, among other

things, that the documentation provided by Dr. Henson supported

a lower level of office visit than the one billed and for which

p ayment was received and, therefore, the difference between the

payment for the appropriate level of service and the amount

actually paid was an overpayment; that some of Dr. Henson's

medical records failed to contain documentation for services

which were b illed and for which payment was made and, therefore,

the payments for the inappropriate documentation was an

overpayment; that some of the services rendered were

inappropriately coded and the difference between payment for the

proper code and the inappropr iate code was an overpayment; and

that some of the services for which billing was made and payment

received w ere not medically necessary and those services were

disallowed and were, therefore, an overpayment.

11. The FAAR further provided how the overpaym ent was

calculated, indicating, among other things, that a sample of 30

recipients of the 2936 claims submitted by Dr. Henson were

reviewed for the period from January 1, 1998 through

September 30, 2000; that a statistical formula for cluster

sampling, wit h the formula being presented, was used; that the

statistical formula was generally accepted; and that the

statistical formula showed an overpayment in the amount of

$124,556.83, with a 95 percent probability of correctness.

12. The majority of the overpa yment was due to denied

claims for intravenous infusions of multi - vitamins, epogen and

nupogen to adult HIV/AIDS patients.

13. AHCA's representative primarily responsible for

handling the audit of Dr. Henson was Sharon Dewey, a registered

nurse employed i n the Medicaid Program Integrity (MPI) division

of AHCA. Nurse Dewey conducted an audit of Medicaid payments

only under Dr. Henson's Medicaid Provider number.

14. An on - site visit of Dr. Henson's office was made by

Nurse Dewey. During the on - site visit , she provided Dr. Henson

with a questionnaire , which was completed by her and signed by

Dr. Henson , and which indicated that Dr. Henson was the only

Medicaid Provider at the office at which he was located, Latin

Quarter Medical Center, 855 Southwest 8th S treet, Miami,

Florida.

15. At the on - site visit, Dr. Henson provided all of the

medical documentation and medical recipient records for the

audit period involved. All the Medicaid claims for the medical

recipients were paid Medicaid claims originating on ly from

Dr. Henson's Medical Provider number.

16. Dr. Henson made available and provided to AHCA or

AHCA's representatives any and all required Medicaid - related

records and information pertaining to the audit that he had in

his possession. 4 He never refu sed to allow access to the records

or information.

17. Having received the medical recipient records from

Dr. Henson, Nurse Dewey organized the records by patient names

and dates of service and provided them to Dr. Joseph W. Shands,

Jr., along with a work sheet for the audited claims for each

patient.

18. Dr. Shands is an expert in infectious diseases and the

treatment and management of AIDS and HIV. Dr. Shands retired in

2002, and his practice was basically the same as Dr. Henson. No

objection was made at hearing that Dr. Shands met the statutory

definition of "peer." § 409.9131(1)(c), Florida Statutes

(1999). 5 The undersigned finds Dr. Shands' testimony persuasive.

19. Dr. Shands reviewed the medical documentation provided

by Dr. Henson to AHCA. The medical documentation that he

reviewed indicated that the patients were "all HIV AIDS

patients." Dr. Shands reviewed the particular medications given

the patients; reviewed the reasons why the medications were

given; considered and made a determination a s to whether a

justification existed for the administration of the medication;

and, based on his determination, either allowed or disallowed

the claim. He made no determinations as to the actual dollar

amount of services provided.

20. After reviewing the medical records, Dr. Shands made

notations on the worksheets, signed the worksheets, and returned

the worksheets to Nurse Dewey.

21. Specific instances of acute attention involved the

administration of intravenous (IV) multi - vitamins, epogen,

nupogen, an d Intravenous Immunoglobulin (IVIG).

22. As to the IV of multi - vitamins, Dr. Henson prescribed

this administration for almost all of his patients. Dr. Shands

found that the patients were coming into the facility two to

three times a week for the treatmen t , but he found no documented

medical information to justify the use of IV multi - vitamins and

determined these services were not medically necessary. In

Dr. Shands' opinion an oral multi - vitamin would have been more

appropriate and achieved the same resul t. An oral multi - vitamin

is not recommended, according to Dr. Shands, where the patient

is unable to digest the oral multi - vitamin. Notably, for one

patient a notation was made that the patient refused pills , but

a further notation indicated that Dr. Hen son had prescribed the

same patient pill - based medications for treatment, which negated

the basis for the intravenous use. Furthermore, IV

administration to an HIV/AIDS patient places the patient at an

unnecessary risk of infection, which is not present w ith oral

multi - vitamins.

23. Dr. Henson testified that he was continuing the

treatment of another physician, but he failed to make an

independent medical judgment based upon his own medical

findings. Further, no justification was in the medical records

f or the former physician's administration of IV multi - vitamins.

24. Additionally, IV multi - vitamin s w ere more costly than

oral administration. And, with patients returning to the

facility two to three times a week, the cost increased even

more.

25. Rega rding epogen, Dr. Shands opined that certain

administration was not medically necessary for the HIV/AIDS'

patients.

26. As to nupogen, Dr. Shands opined that certain

administration was not medically necessary for the HIV/AIDS'

patients.

27. Regarding the administration of IVIG, Dr. Shands

opined that the administration was not medically necessary for

the HIV/AIDS' patients.

28. As to certain office visits for the administration of

IV multi - vitamins, epogen, nupogen, and IVIG, Dr. Shands opined

that the o ffice visits were unnecessary.

29. Using the worksheets, with Dr. Shands' notations on

them, together with Dr. Shands denials or reductions, Nurse

Dewey calculated the overpayment associated with each of

Dr. Henson's patients.

30. Subsequently, a statist ical calculation was applied by

AHCA to extend the audit sample's total overall payment to all

of Dr. Henson's Medicaid claims during the audit period, which

resulted in a determination of an overpayment in the amount of

$124,556.83.

31. Dr. Henson sugges ts that his signature may have been

falsified or forged on the medical records and information that

he submitted to AHCA for its audit. Prior to hearing, he had an

opportunity to review the medical records and information but

could not identify one instan ce that his signature was falsified

or forged. Consequently, a finding of fact is made that

Dr. Henson signed the medical records and documentation provided

to AHCA by him for the audit.

32. Dr. Henson presented no expert testimony or any

testimony to su pport the medical necessity or cost - effectiveness

of the procedures that he used.

33. Further, Dr. Henson contends that Latin Quarter

Medical Center, the facility that employed him, received the

Medicaid payments , not h e . However, as the Medicaid Provide r,

he was not relieved of his responsibility to make sure that the

medical procedures were medically necessary and cost - effective.

CONCLUSIONS OF LAW

34. The Division of Administrative Hearings has

jurisdiction over the subject matter of this proceeding a nd the

parties thereto pursuant to Sections 120.569 and 120.57(1),

Florida Statutes (2006).

35. The burden of proof is on AHCA to establish a Medicaid

overpayment by a preponderance of the evidence. South Medical

Services, Inc. v. AHCA , 653 So. 2d 440, 4 41 (Fla. 3d DCA 1995).

36. Section 409.913, Florida Statutes (2001), provides in

pertinent part:

(21) The audit report, supported by agency

work papers, showing an overpayment to a

provider constitutes evidence of the

overpayment. . . .

Pursuant to the said subsection, AHCA can establish a prima

facie case of overpayment merely by the admission into evidence

of a properly supported audit report. See Maz Pharmaceuticals,

Inc. v. Agency for Health Care Administration , DOAH Case No. 97 -

3791 (Recommended O rder, March 20, 1998).

37. During the audit period, AHCA was charged with

overseeing Florida's Medicaid program, including the program's

integrity. Section 409.913, Florida Statutes (1998 - 2000) ,

provided in pertinent part that AHCA "shall operate a progr am to

oversee the activities of Florida Medicaid recipients, and

providers and their representatives, to ensure that fraudulent

and abusive behavior and neglect of recipients occur to the

minimum extent possible, and to recover overpayments and impose

sanc tions as appropriate." 6

38. The Florida Legislature made provisions for AHCA to

discover the fraud, abuse, and neglect and to recover

overpayments. Section 409.913(2), Florida Statutes (1998 - 2000),

provides in pertinent part that AHCA "shall conduct, or cause to

be conducted by contract or otherwise, reviews, investigations,

analyses, audits, or any combination thereof, to determine

possible fraud, abuse, overpayment, or recipient neglect in the

Medicaid program and shall report the findings of any

overpa yments in audit reports as appropriate." 7

39. An affirmative duty is placed on Medicaid providers by

Section 409.913(7), Florida Statutes (1996 - 2000), to ensure

goods and services, providing in pertinent part:

(b) Are Medicaid - covered goods or services

t hat are medically necessary.

* * *

(e) Are provided in accord with applicable

provisions of all Medicaid rules,

regulation, handbooks, and policies and in

accordance with federal, state, and local

law.

(f) Are documented by records made at the

tim e the goods or services were provided,

demonstrating the medical necessity for the

goods or services rendered. Medicaid goods

or services are excessive or not medically

necessary unless both the medical basis and

the specific need for them are fully and

p roperly documented in the recipient's

medical record.

40. Medical necessity or medically necessary is defined in

Section 409.913(1)(c), Florida Statutes (1996 - 2000), as "any

goods or services necessary to palliate the effects of a

terminal condition, or to prevent, diagnose, correct, cure,

alleviate, or preclude deterioration of a condition that

threatens life, causes pain or suffering, or results in illness

or infirmity, which goods or services are provided in accordance

with generally accepted standards of medical practice. ”

41. Furthermore, the Chapter 2 of the Physician Services

Covered Services, Limitations, and Exclusions Handbook, November

1997, January 1999, and January 2000, at page 2 - 2, and the

Medicaid Provider Reimbursement Handbook, HCFA - 1500 and Child

Health Check - Up 221 (Medicaid Provider Reimbursement Handbook),

July 1999, at page D - 10, defines medically necessary services,

in part, as those services reflecting the level of service "that

can be safely furnished, and for which no equally eff ective and

more conservative or less costly treatment is available

statewide . . . . "

42. As to maintaining records necessary to demonstrate

medically necessary goods or services, Section 409.913(8),

Florida Statutes (1996 - 2000), imposes certain requireme nts and

provides in pertinent part:

(8) A Medicaid provider shall retain

medical, professional, financial, and

business records pertaining to services and

goods furnished to a Medicaid recipient and

billed to Medicaid for a period of 5 years

after the dat e of furnishing such services

or goods. . . .

43. Furthermore, the Medicaid Provider Reimbursement

Handbook, July 1999, page 2 - 19, provides that a provider "must

retain," for a period of "at least five years from the date of

service," all medical, fiscal , professional, and business

records on all services provided to a Medicaid recipient; and at

page 2 - 20 that the "medical records must state the necessity for

and the extent of services provided."

44. Failure of a Medicaid provider to comply with the

af orementioned requirements subjects the Medicaid provider to

repayment action by AHCA. Section 409.913(10), Florida Statutes

(1996 - 2000), provides that "The agency may require repayment for

inappropriate, medically unnecessary, or excessive goods or

servic es from the person furnishing them, the person under whose

supervision they were furnished, or the person causing them to

be furnished."

45. Overpayment is defined by Section 409.913(1)(d),

Florida Statutes (1996 - 2000), as including "any amount that is

no t authorized to be paid by the Medicaid program whether paid

as a result of inaccurate or improper cost reporting, improper

claiming, unacceptable practices, fraud, or abuse, or mistake. ”

46. The following were admissions made by Dr. Henson in

the Request for Admissions: 8

a. The stated purpose behind the five - year document

retention requirement of Section 409.907(3)(c), Florida

Statutes, is so that Dr. Henson can "satisfy all necessary

inquiries by the agency [AHCA]."

b. Section 409.913(7)(f), Florida St atutes, imposes an

affirmative duty on Dr. Henson to make sure that any claim for

goods and services are "documented by records made at the time

good and services were provided."

c. Section 409.913(7)(f), Florida Statutes, imposes an

affirmative duty on Dr. Henson to make sure that any [sic] all

the records documenting Medicaid goods and services demonstrate

"the medical necessity for the goods and services rendered."

d. Section 409.913(7)(f), Florida Statutes, declares that

Medicaid goods and services are "excessive or medically

unnecessary, unless both the medical basis and the specific need

for them are fully and properly documented in the recipient's

medical record."

e. Section 409.913(7)(f), Florida Statutes, authorizes

AHCA to investigate, review, or analyze the records, including

Medicaid - related Records, that Dr. Hinson is required to retain.

f. Section 409.913(1)(c), Florida Statutes, states in part

that, "Determinations of medical necessity . . . must be based

upon information available at the time goods or services are

provided."

g. Section 409.913(1)(d), Florida Statutes, defines

"overpayment" as, "any amount that is not authorized to be paid

by the Medicaid program whether paid as a result of inaccurate

or improper cost reporting, improper claiming, unacceptable

practices, fraud, abuse, or mistake."

47. AHCA demonstrated a prima facie case of Medicaid

overpayment to Dr. Henson in the amount of $124,556.83 for the

audit period.

48. Dr. Henson failed to present sufficient evidence to

rebute , refute or otherwise undermine the evidence presented by

AHCA.

49. AHCA demonstrated that the services provided by

Dr. Henson were not in compliance with Medicaid reimbursement

requirements; that it used accepted and valid auditing and

analytical methods in determining the Medicaid overpayment; and

that Dr. Henson received Medicaid overpayments in the amount of

$124,556.83 for the audit period January 1, 1998 through

September 30, 2000.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusion s of

Law, it is

RECOMMENDED that the Agency for Health Care Administration

enter a final order finding that Arthur Henson, D.O., received

overpayments in the Medicaid program in the amount of

$124,556.83, during the audit period January 1, 1998 through

Sep tember 30, 2000, and requiring Arthur Henson, D.O., to repay

the overpayment amount.

DONE AND ENTERED this 29th day of June, 2006, in

Tallahassee, Leon County, Florida.

S

__________________________________

ERRO L H. POWELL

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 th e

Division of Administrative Hearings

this 29th day of June, 2006.

ENDNOTES

1/ Admitted in Request for Admissions.

2/ Id.

3/ Id.

4/ Id.

5/ Section 409.9131(2)(c), Florida Statutes (1999), defines

"peer" as "a Florida licensed physician who is, to the maximum

extent possible, of the same specialty or subspecialty, licensed

under the same chapter, and in active practice."

6/ This statutory provision was also applicable in 1996 and

1997.

7/ Id.

8/ The statutory provisions indicated were agre ed upon as

applicable during the audit period 1998 through 2000.

COPIES FURNISHED:

Kevin J. Kulik, Esquire

Kevin J. Kulik, P.A.

600 South Andrews Avenue, Suite 500

Fort Lauderdale, Florida 33301

Anthony L. Conticello, Esquire

Agency for Health Care Ad ministration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Alan Levine, Secretary

Agency for Health Care Administration

Fort Knox Building, Suite 3116

2727 Mahan Drive

Tallahassee, Florida 32308

Christa Calamas, General Counsel

Agency for Health Care Administration

Fort Knox Building, Suite 3431

2727 Mahan Drive, Mail St ation 3

Tallahassee, Florida 32308

Richard Shoop, Agency Clerk

Agency for Health Care Administration

Fort Knox Building, Suite 3431

2727 Mahan Drive, Mail Station 3

Talla hassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this recommended order. Any exceptions

to this recommended order should be filed with the agency that

wi ll issue the final order in this case.