07-001682MPI Agency For Health Care Administration vs. John M. Assi, M.D. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, August 1, 2007.

STATE OF FLORIDA FILED

DIVISION OF ADMINISTRATIVE HEARINGS AJ1CA

AGENCY CLERK

STATE OF FLORIDA AGENCY FOR lOOq OCT 13 A 10 28

HEALTH CARE ADMINISTRATION

Petitioner

DOAH Case No 07 1680MPI

vs PROVIDER NO 0448524 04

AHCA C I No 05 3601 000

JOHN M ASSI M D RENDITION NO AHCA 09 tot S MDO

Respondent

STATE OF FLORIDA AGENCY FOR

HEATLH CARE ADMINISTRATION

Petitioner

vs DOAH Case No 07 1681MPI

PROVIDER NO 0448524 00

JOHN M ASSI M D AHCA C I No 05 3602 000

Respondent

STATE OF FLORIDA AGENCY FOR

HEALTH CARE ADMINISTRATION

Petitioner

vs DOAH Case No 07 1682MPI

PROVIDER NO 0448524 02

JOHN M ASSI M D AHCA C I No 05 3603 000

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a settlement agreement which

is attached and incorporated by reference 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 day of ado h Lr 2009 in

Tallahassee Florida

If dJL r

Holly Benson Secretary I

Agency for Health Care Administration

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

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

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

SECOND COpy ALONG WITH FILING FEE AS PRESCRIBED BY LAW WITH THE

DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE

AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES

REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE

FLORIDA APPELLATE RULES THE NOTICE OF APPEAL MUST BE FILED

WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED

Copies Furnished to

Scott Wicke

EmCare

1717 Main Street

Suite 5200

Dallas TX 75201

Karen Dexter Assistant General Counsel

Agency for Health Care Administration

Interoffice

Peter Williams Inspector General

Agency for Health Care Administration

Interoffice

D Kenneth Yon Bureau Chief

Medicaid Program Integrity

Interoffice

Finance Accounting

Interoffice

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was served to the

above named addresses by mail or interoffice mail this I ay of e

2009

c

Richard Shoop Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Bldg 3 Mail Stop 3

Tallahassee Florida 32308 5403

850 922 5873

RECEIVED

AHCA

STATE OF FLORIDA GENERAL COUNSEL

DIVISION OF ADMINISTRATIVE HEARINGS

ZOOq SEP 2 A 10 53

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs Case Nos 07 1680 MPI

C I No 05 3601 000

JOHN M ASSI M D Provider No 044852404

Respondent

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs Case No 07 1681MPI

C I No 05 3602 000

JOHN M ASSI M D Provider No 0448524 00

Respondent

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs Case No 07 1682MPI

C I No 05 3603 000

JOHN M ASSI M D Provider No 044852402

Respondent

SETTLEMENT AGREEMENT

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

ARCA or the Agency and John M Assi M D PROVIDER by and through the

undersigned hereby stipulate and agree as follows

1 The two parties enter into this agreement for the purpose of memorializing the

resolution to these matters

2 PROVIDER is a Medicaid provider in the State of Florida with provider numbers

0448524 04 0448524 00 0448524 02 and was a provider during the audit period

3 In its three Final Audit Reports final agency action dated February 27 2007

ARCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program

Integrity MPI Office of the ARCA Inspector General indicated that certain claims in whole

or in part has been inappropriately paid by Medicaid The Agency sought recoupment of this

overpayment in the amount of 56 813 26 plus a fine sanction in the amount of 2 500 00 for

C I No 05 3601 00 The Agency sought recoupment in the amount of 71 882 80 plus a fine

sanction in the amount of 2 500 00 for I C No 05 3602 000 and recoupment in the amount of

19 799 40 plus a fine sanction in the amount of 3 000 00 for C I No 05 3603 000

4 In response to the audit letters dated February 27 2007 PROVIDER filed

Petitions for formal administrative hearings which were assigned DOAR Case Nos 07

1680MPI 07 1681MPI and 07 1682 MPI respectively These cases were not consolidated

5 Subsequent to the original audits that took place in these matters and III

preparation for hearing ARCA re reviewed the PROVIDER s claims and evaluated additional

documentation submitted by the PROVIDER As a result ARCA determined that the

overpayments were adjusted to 56 064 87 55 264 69 and 19 799 40 respectively

6 Pursuant to Section 409 913 23 a Florida Statutes the Agency is entitled to

recover all investigative legal and expert witness costs They Agency assessed costs of

1 500 00

7 In accordance with Sections 409 913 15 16 and 17 Florida Statutes and

Rule 59G 9 070 Florida Administrative Code the Agency shall apply sanctions for violations of

federal and state laws including Medicaid policy A fine sanction of 2 500 00 was applied to

audits I C No 05 3601 000 and C No 05 3602 000 for violation s of Rule Section 59G

9 070 e F A C A fine sanction of 3 000 00 was applied to audit C I No 05 3603 000 for

violation s of Rule Section 59G 9 070 e F A C

8 In order to resolve these matters without further administrative proceedings

PROVIDER and the ARCA expressly agree as follows

1 ARCA agrees to accept the payment set forth herein in settlement of the

overpayment issues arising from the MPI reviews referenced above

2 Within thirty days of entry of the final order PROVIDER agrees to remit

payment to the Agency in the amount of one hundred forty thousand six

hundred twenty eight dollars and ninety six cents 140 628 96 which

includes 9 500 in fines and cost in twenty four 24 equal monthly

payments in the amount of six thousand four hundred eighty nine dollars

and thirty one cents 6 489 31 which includes the statutory 10

interest ARCA retains the right to perform a 6 month follow up review

3 PROVIDER and ARCA agree that full payment as set forth above will

resolve and settle these cases completely and release both parties from all

liabilities arising from the fmdings in the audits referenced as C I 05

3601 000 C I 05 3602 000 and C I 05 3603 000

4 PROVIDER agrees that it will not re bill the Medicaid Program in any

manner for claims that were not covered by Medicaid which are the

subject of the audits in these cases

9 Payment shall be made to

AGENCY FOR HEALTHCARE ADMINISTRATION

Medicaid Accounts Receivable

2727 Mahan Drive Mail Stop 14

Tallahassee Florida 32308

10 PROVIDER agrees that failure to pay any monies due and owing under the terms

of this Agreement shall constitute PROVIDER S authorization for the Agency without further

notice to withhold the total remaining amount due under the terms of this agreement from any

monies due and owing to PROVIDER for any Medicaid claims

11 AHCA reserves the right to enforce this Agreement under the laws of the State of

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

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

iparty with respect to this case or any other matter

13 Each party shall bear its own attorneys fees and costs if any

14 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

15 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

16 This Agreement constitutes the entire agreement between PROVIDER and the

AHCA including anyone acting for associated with or employed by them concerning all

matters and supersedes any prior discussions agreements or understandings there are no

promises representations or agreements between PROVIDER and the 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

17 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

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

sections 120 569 or 57 120 Florida Statutes the making of findings of fact and conclusions of

law by the Agency and 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

19 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

20 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

21 This Agreement shall inure to the benefit of and be binding on each party s

successors assigns heirs administrators representatives and trustees

22 All times stated herein are of the essence of this Agreement

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

parties in counterpart

JOHN M ASSI M D

Dated 2009

AJ VI

rint name

ITS

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive Mail Stop 3

Tallahassee FL 32308 5403

Dated J 0 Ie 2009

Peter tL2 1lhams

Inspector General

2009

WA Dated

Justln M Se

General Counsel

Dated I 2 9 2009