08-001995MPI Agency For Health Care Administration vs. City Of Jacksonville Fire Division Rescue Service Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, March 13, 2009.

STATE OF FLORIDA F t LED HCA

DIVISION OF ADMINISTRATIVE HEARINGS AGENCY CLERK

AGENCY FOR HEALTH CARE Znnq OCT 30 P I I q

ADMINISTRATION

Petitioner

vs CASE NO 08 1995MPI

RENDITION NO AHCA 09 1l D4 S MDO

CITY OF JACKSONVILLE FIRE

DIVISION RESCUE SERVICE

Respondent

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a

Stipulation and Agreement which is attached and incorporated by

reference The parties are directed to comply with the terms of

the attached Stipulation and Agreement Based on the foregoing

this file is CLOSED

DONE AND ORDERED this day of e1 2009

in Tallahassee Leon County Florida

T t Secretary

Agency for Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS

ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING

THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF ARCA AND

A COPY ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED

Case No 08 1995MPI

ARCA vs City of Jacksonville Fire Division Rescue Service

Final Order

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the

foregoing was furnished by United States Mail and by facsimile

transmission 904 630 1731 to Loree L French Esquire Attorney

for the Respondent City of Jacksonville 117 West Duval Street

Suite 480 Jacksonville Florida 32202 this j day of

October 2009

A9

A

RICHARD J SHOOP Y Clerk

Agency for Health Care Administration

2727 Mahan Drive MS 3

Tallahassee FL 32308

850 922 5873

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

v CASE NO 08 1 995MPI

CITY OF JACKSONVILLE FIRE DIVISION

RESCUE SERVICE

Respondent

STIPULATION AND AGREEMENT

The AGENCY FOR HEALTH CARE ADMINISTRATION alk a and hereinafter

AHCA or the Agency and CITY OF JACKSONVILLE FIRE DIVISION RESCUE

SERVICE alk a and hereinafter JACKSONVILLE or PROVIDER by and through the

undersigned hereby stipulate and agree to the following

I The parties enter into this agreement for the purpose of memorializing the

resolution to this matter

2 JACKSONVILLE is a Medicaid provider in the State of Florida operating under

PROVIDER Number 0881040 00

3 In its Final Audit Report C Number 08 6158 000 the Audit Letter or

FAR dated March 24 2008 AHCA notified JACKSONVILLE that review of Medicaid

claims performed by Medicaid Program Integrity MPI indicated that in its opinion some

claims in whole or in part were not covered by Medicaid The Agency sought repayment of an

overpayment in the amount of Thirteen Thousand Four Hundred Eighty Five Dollars and

Twenty Three cents 13 485 23 AHCA also notified JACKSONVILLE in the FAR that it is

Page 1 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

seeking sanction in the form of a Five Hundred Dollars 500 00 fme and a Corrective Action

Plan in the form of a PROVIDER Acknowledgement Statement The sanctions were determined

pursuant to Rule 59G 9 070 Florida Administrative Code In response JACKSONVILLE

petitioned for a formal administrative hearing JACKSONVILLE s challenge to the Medicaid

overpayment determination was referred to the Division of Administrative Hearings DOAH

for assignment to an Administrative Law Judge and assigned DOAH Case Number 08 l995MPI

After JACKSONVILLE requested a formal administrative hearing AHCA reviewed the

documentation submitted by JACKSONVILLE which was previously unavailable to the

Agency and adjusted the FAR overpayment determination

4 Both parties stipulate and agree that JACKSONVILLE shall pay a Medicaid

overpayment amount of One Hundred and Eight Dollars 108 00 a sanction in the amount of

Thirty Two Dollars and Forty cents 40 32 and some of AHCA s costs in the amount of One

Hundred Forty Five Dollars 145 00 for a total overpayment amount of Two Hundred Eight

Five Dollars and Forty cents 285 40 In addition JACKSONVILLE agrees to complete a

Corrective Action Plan in the form of a Provider Acknowledgement Statement which is

incorporated by reference into this Stipulation and Agreement

5 In order to resolve DOAH Case Number 08 1995MPI without further

administrative proceedings AHCA and JACKSONVILLE expressly agree as follows

a AHCA will accept the adjusted overpayment sanction fine and costs set forth

herein as a complete resolution of the overpayment issues arising from the MPI

review cited in paragraphs four 4 and three 3 above

b The adjusted Medicaid overpayment amount of One Hundred and Eight Dollars

108 00 sanction in the total amount of Thirty Two Dollars and Forty cents

Page 2 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

32 40 and costs in the amount of One Hundred and Forty Five Dollars

145 00 shall be paid as follows Within thirty 30 days of the issuance of the

Final Order JACKSONVILLE agrees to pay a single payment to AHCA in the

amount of Two Hundred Eight Five Dollars and Forty cents 285 40

c The Agency retains the right to perform a six 6 month follow up review

d JACKSONVILLE and AHCA agree that full payment as set forth above will

resolve and settle DOAH Case Number 08 1995MPI completely and release all

parties from all liabilities arising from the findings in the audit referenced as C

Number 08 6158 000

e JACKSONVILLE agrees that it will not rebill the Medicaid Program in any

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

audit in this case

f JACKSONVILLE agrees fo fully cooperate with any follow up reviews

conducted by the Agency

6 Payment shall be made to

AGENCY FOR HEALTHCARE ADMINISTRATION

Medicaid Accounts Receivable

Post Office Box 13749

Tallahassee Florida 32317 3749

And payment shall clearly indicate that it is per a stipulation and agreement and shall reference

the C I Number and the Provider Number

7 JACKSONVILLE agrees that failure to pay any monies due and owing under the

terms of this Agreement shall constitute JACKSONVILLE s authorization for the Agency

Page 3 of9

DOAH Case No 08 1995MPI

AHCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

without further notice to withhold the total remaining amount due under the terms of this

agreement from any monies due and owing to JACKSONVILLE for any Medicaid claims

8 AHCA reserves the right to enforce this Stipulation and Agreement under the

laws of the State of Florida the Rules of the Medicaid Program and all other applicable rules

and regulations

9 Except as specifically provided in paragraphs 4 5a and 5b above the parties

agree to bear their own attorney s fees and other costs if any

10 As a part of this Stipulation and Agreement JACKSONVILLE agrees that AHCA

may impose administrative sanctions pursuant to Rule 59G 9 070 Florida Administrative Code

as referenced in paragraph 4 above

11 JACKSONVILLE as its PROVIDER Acknowledgment Statement Corrective

Action Plan acknowledges the obligation of CITY OF JACKSONVILLE FIRE DIVISION

RESCUE SERVICE to adhere to state and federal laws rules provisions handbooks and

policies In addition CITY OF JACKSONVILLE FIRE DIVISION RESCUE SERVICE

acknowledges that Medicaid policy requires as follows

Pursuant to the Florida Medicaid Provider General Handbook Chapter 5 4 Provider

Responsibility

When reviewing a claim for payment under the Medicaid Program a Provider

has an affirmative duty to supervise the provision of and be responsible for

goods and services claimed to have been provided to supervise and be

responsible for preparation and submission of a claim and to present a claim

that is true and accurate and that is for goods and services that

Page 4 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

Have actually been furnished to the recipient by the Provider prior to

submitting the claim

Are Medicaid covered services that are medically necessary

Are of a quality comparable to those furnished to the general public by

the Provider s peers

Have not been billed in whole or part to a recipient s responsible party

except for such co payments co insurance or deductions as authorized by

AHCA

Are provided in accord with applicable provisions of all Medicaid

rules regulations handbooks and policies and in accord with federal state and

local law and

Are documented by records made at the time 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 the medical basis and the specific need for them are fully documented

in the recipient s medical record

12 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

Furthermore JACKSONVILLE agrees that its signature alone binds JACKSONVILLE to make

the payment as set forth in this agreement JACKSONVILLE shall furnish the actual signed

Stipulation and Agreement to AHCA however a facsimile copy shall be sufficient to enable

ARCA to cancel a hearing scheduled in this case

Page 5 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

13 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

14 This Agreement constitutes the entire agreement between JACKSONVILLE and

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 JACKSONVILLE 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

15 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 This Stipulation and

Agreement does not constitute an admission of wrongdoing or error by either party with respect

to this case or any other matter However the parties believe that this matter should be resolved

because the parties have agreed to the terms contained within this agreement

16 JACKSONVILLE 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 of

law by DOAH and 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

JACKSONVILLE further agrees that the Agency should issue a Final Order which is consistent

with the terms of this Stipulation and Agreement and which adopts this agreement and closes

this matter as to DOAH Case Number 08 l995MPI

Page 6 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

17 JACKSONVILLE does hereby discharge the State of Florida Agency for Health

Care Administration and its agents representatives and attorneys of and from all claims

demands actions causes of action suits damages losses and expenses of any and every nature

whatsoever arising out of or in any way related to DOAH Case Number 08 1 995MPI C No

08 6158 000 and ARCA s actions herein including but not limited to any claims that were or

may be asserted in any federal or state court or administrative forum including any claims

arising out of this agreement by or on behalf of JACKSONVILLE

18 This Stipulation and 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

19 To the extent that any provision of this Stipulation and 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 Stipulation and Agreement

20 This Stipulation and Agreement shall inure to the benefit of and be binding on

each party s successors assigns heirs administrators representatives and trustees

21 All times stated herein are of the essence in this Stipulation and Agreement

22 This Stipulation and Agreement shall be in full force and effect upon execution by

the respective parties in counterpart

Page 7 of9

DOAR Case No 08 1995MPI

ARCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

CITY OF JACKSONVILLE FIRE

DIVISION RESCUE SERVICE

BY o

Date 2009

CITY OF JACKSONVILLE

GENERAL COUNSEL S OFFICE

BY

LO

Att ey for CITY OF JACKSONVILLE

FIRE DIVISION RESCUE SERVICE

Date Z 2009

LA f

Page 8 of9

DOAH Case No 08 1995MPI

AHCA v City Of Jacksonville Fire Division Rescue Service

Stipulation and Agreement

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive Mail Stop 3

Tallahassee FL 32308 5403

BY j

PE1 H WILLIAMS

Inspector General

Date Q t b 2009

BY

ms

General Counsel

Date od h lh 2009

BY r

DEBORA E FRIDIE

Assistant General Counsel

Date o Ck bu zg 2009

Page 9 of9

PROVIDER ACKNOWLEDGEMENT STATEMENT

I Charles MOt elanc on behalf of Fire Div Rescue Service

insert printed full name here

a Medicaid provider operating under provider number 0881040 00 do hereby

acknowledge the obligation of Fire Div Rescue Service to adhere to state and federal

Medicaid laws rules provisions handbooks and policies Additionally Fire Div Rescue

Service acknowledges that Medicaid policy requires

The Florida Medicaid Provider General Handbook states in Chapter 5 4 Provider

Responsibility

When presenting a claim for payment under the Medicaid program a provider has an

affirmative duty to supervise the provision of and be responsible for goods and services

claimed to have been provided to supervise and be responsible for preparation and

submission of the claim and to present a claim that is true and accurate and that is for

goods and services that

Have actually been furnished to the recipient by the provider prior to submitting

the claim

Are Medicaid covered services that are medically necessary

Are of a quality comparable to those furnished to the general public by the

provider s peers

Have not been billed in whole or in part to a recipient s responsible party except

for such co payments coinsurance or deductibles as are authorized by AHCA

Are provided in accord with applicable provisions of all Medicaid rules

regulations handbooks and policies and in accord with federal state and local

law and

Are documented by records made at the time 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 the medical

basis and the specific need for them are fully documented in the recipient s

m e l re co d

dicuar 1 0

By k Date f

SIgnature

10 c f Ik c

title

Return completed acknowledgement statement to Office of Inspector General

Medicaid Program Integrity

Corrective action plan Acknowledgement Statement

Final Agency Audit Report March 24 2008

C 08 6158 000