08-002783MPI Agency For Health Care Administration vs. Hector A. Lalama, M.D. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, April 20, 2009.

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STATE OF FLORIDA AHCA

DIVISION OF ADMINISTRATIVE HEARINGS AGENCY CLERK

znoq JUL 1 P 12 3lf

AGENCY FOR HEALTH CARE

ADMINISTRA nON

Petitioner

vs CASE NO 08 2783MPI

c No 06 4553 000

HECTOR A LALAMA RENDITION NO AHCA 09 S MDO

51 1

Respondent

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Settlement Agreement 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 200 III

Tallahassee Florida

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HOLLY BENSON SECRETARY

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

Karen Dexter Esquire

Agency for Health Care

Administration

Laserfiche

Louise Jeroslow

6075 Sunset Drive Suite 201

Miami Florida 33143

U S Mail

Claude B Arrington

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee Florida 32399 3060

Ken Yon Chief Medicaid Program Integrity

Fred Becknell Medicaid Program Integrity

Finance and Accounting

1

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 on this the f It 2007

Richard Shoop Esquire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive Building 3

Tallahassee Florida 32308 5403

850 922 5873

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs CASE NO 08 2783MPI

C No 06 4553 000

HECTOR A LALAMA M D

Respondent

SETTLEMENT AGREEMENT

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

AHCA or the Agency and Hector A Lalama 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 this matter

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

0580856 00 and was a provider during the audit period

3 In its Final Audit Report final agency action dated May 20 2008 AHCA

notified PROVIDER that review of Medicaid claims performed by Medicaid

Program Integrity

MPI Office of the AHCA Inspector General indicated that certain claims in whole or in part

has been inappropriately paid by Medicaid The Agency of this

sought recoupment

overpayment in the amount of 62 033 84 plus a fine sanction in the amount of 2 500 00 In

response to the audit letter dated May 20 2008 PROVIDER filed a petition for a formal

administrative hearing which was assigned DOAH Case No 08 2783

Hector A Lalama M D

Settlement Agreement

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

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

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

overpayment was adjusted to 54 564 10

5 In order to resolve this matter without further administrative proceedings

PROVIDER and the AHCA expressly agree as follows

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

overpayment issues arising from the MPI review

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

payment to the Agency in the amount of fifty seven thousand sixty tour

dollars and ten cents 57 064 10 which includes 2 500 in fines in one

lump sum ROVIDER agrees to submit a Corrective Action Plan in the

form of a Provider Acknowledgement Statement AHCA retains the right

to perform a 6 month follow up review

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

resolve and settle this case completely and release both parties from all

liabilities arising from the findings in the audit referenced as C 06 4553

000

4 PROVIDER 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

Hector A Lalama M D

Settlement Agreement

6 Payment shall be made to

AGENCY FOR HEAL THCARE ADMINISTRATION

Medicaid Accounts Receivable

Post Office Box 13749

Tallahassee Florida 32317 3749

7 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

8 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

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

party with respect to this case or any other matter

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

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

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 Florida

County

13 This Agreement constitutes the entire agreement between PROVIDER and the

AHCA including anyone acting for associated with or them all

employed by concerning

matters and supersedes any prior discussions agreements or urtderstandings 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

Hector A Lalama M D

Settlement Agreement

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 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

16 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

17 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

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

successors assigns heirs administrators representatives and trustees

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

Hector A Lalama M D

Settlement Agreement

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

parties in counterpart

Dated j1 D I 2009

ITS

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive Mail Stop 3

Tallanassce FL 32308 5403

oo Dated 7 t 2009

Peter Nilliams

Inspector General

Dated 6hr r 2009

JUf s

Ac ting General COlmsel

Dated s 2009

I g en extet

Assistant General Counsel