08-003219MPI Agency For Health Care Administration vs. Ronald G. Davis, M.D. And Pediatric Neurology Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, March 5, 2009.

STATE OF FLORIDA FiL ED

DIVISION OF ADMINISTRATIVE HEARINGS AGaftl tLERK

AGENCY FOR HEALTH CARE zonq AUG 13 A 10 31

ADMINISTRATION

Petitioner

vs DOAH Case No 08 3219MPI

RENDITION NO AHCA 09 lP6 S MDO

RONALD G DAVIS M D and

PEDIATRIC NEUROLOGY P A

Respondent

RONALD G DAVIS M D and

PEDIATRIC NEUROLOGY P A

Petitioner

vs DOAH Case No 08 3261RU

AGENCY FOR HEALTH CARE

ADMINISTRATION

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 ofthe attached Stipulation and Agreement Based on the foregoing this file is CLOSED

DONE AND ORDERED this LL day of 2009 in Tallahassee

Leon County Florida

t

Holly Benson Secretary

Agency for Health Care Administration

Page 1 of2

DOAH Cases No 08 32l9MPI and 08 326lRU

AHCA v Davis and Davis v AHCA

Final Order

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

William F Quattlebaum

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee Florida 32399 3060

Tracy Mabry Esquire

Dean Mead Egerton Bloodworth

Capouano Bozarth P A

800 North Magnolia Avenue

Suite 1500

Orlando Florida 32803

Debora Fridie Senior Attorney

Agency for Health Care Administration

Interoffice

Robi Olmstead

AHCA Administrator MPI

Agency for Health Care Administration

2727 Mahan Drive Mail Stop 6

Interoffice

Finance Accounting

Agency for Health Care Administration

Interoffice

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DOAR Cases No 08 32 I 9MPI and 08 3261RU

ARCA v Davis and Davis v ARCA

Final Order

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy ofthe foregoing has been furnished to

the above named addressees by U S Mail and or Interoffice Mail on this the 13 ay of

t 2009

4J

Richard Shoop Esquire

Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Mail Stop 3

Tallahassee Florida 32308 5403

Page 3 of3

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs DOAH Case No 08 3219MPI

RONALD G DAVIS M D and

PEDIATRIC NEUROLOGY P A

Respondent

RONALD G DAVIS M D and

PEDIATRIC NEUROLOGY P A

Petitioner

vs DOAH Case No 08 3261RU

AGENCY FOR HEALTH CARE

ADMINISTRATION

Respondent

STIPULATION AND AGREEMENT

The AGENCY FOR HEALTH CARE ADMINISTRATION hereinafter the Agency or

AHCA and RONALD G DAVIS M D and PEDIATRIC NEUROLOGY P A hereinafter

the DA VIS by and through the undersigned hereby stipulate and agree to the following

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

resolution to this marter

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

Number 2625105 00

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Stipulation and Agreement

3 In its Final Audit Report C I Number 07 5558 000 the Audit Letter or

FAR dated April 22 2008 AHCA notified DAVIS 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 One Hundred Forty Nine Thousand Five Hundred Forty Eight Dollars and Twenty

cents 149 548 20 AHCA also notified DAVIS in the FAR that it is seeking sanctions in the

form of a Three Thousand Dollar 3 000 00 fine and a Corrective Action Plan in the form of a

Provider Acknowledgement Statement The sanctions were determined pursuant to Rule

590 9 070 Florida Administrative Code In response DAVIS petitioned for a formal

administrative hearing DAVIS 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 3219MPI DAVIS also filed

with DOAH an unpromulgated rule challenge and therein challenged some of Medicaid s

provider enrollment policies That rule challenge was assigned to an Administrative Law Judge

and assigned DOAH Case Number 08 3261RU Subsequently the Judge entered an Order dated

July 22 2008 consolidating DOAH Case Number 08 3219MPI and Case Number 08 3261RU

4 After the provider requested a formal administrative hearing AHCA reviewed

documentation that was previously unavailable to them Based upon that review AHCA adjusted

the overpayment determination Both parties stipulate and agree that DAVIS shall pay an

adjusted Medicaid overpayment amount of Nineteen Thousand Seven Hundred Thirty Dollars

and Thirty Four Cents 19 730 34 total sanctions of Three Thousand Dollars 3 000 00

which are broken down as follows

a One Thousand Dollars 1 000 00 for non enrolled providers

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Stipulation and Agreement

b One Thousand Dollars 1 000 00 for billing for services rendered by other

providers

c Five Hundred Dollars 500 00 for no signature on medical records and

d Five Hundred Dollars 500 00 for no documentation or missing pages of

documentation

and some of AHCA s investigative costs in the amount of Five Hundred Dollars 500 00 for a

total overpayment amount of Twenty Three Thousand Two Hundred Thirty Dollars and Thirty

Four Cents 23 230 34 In addition DAVIS agrees to complete a Corrective Action Plan in the

form of a Provider Acknowledgement Statement which is incorporated by reference in this

Stipulation and Agreement

5 In order to resolve DOAH Case Number 08 3219MPI and Case Number

08 3261RU without further administrative proceedings AHCA and DAVIS expressly agree as

follows

a AHCA will accept the payment set forth herein as a complete resolution of the

overpayment issues arising from the MPI review cited in paragraph four 4

above

b Within thirty 30 days of issuance of the Final Order DA VIS agrees to make a

single payment to AHCA of Twenty Three Thousand Two Hundred Thirty

Dollars and Thirty Four Cents 23 230 34 which amount includes the adjusted

Medicaid overpayment sanctions and costs AHCA retains the right to perform a

six month follow up review

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DOAH Cases No 08 3219MPI and 08 3261RU

AHCA v Davis and Davis v AHCA

Stipulation and Agreement

c DAVIS is responsible for ensuring timely delivery of the payment Failure to

timely make the payment will render the balance due and payable immediately

with interest and interest will continue to accrue until the entire balance is paid

d DA VIS and AHCA agree that full payment as set forth above will resolve and

settle both DOAH Case Number 08 3219MPI and Case Number 08 3261RU

completely and release all parties from all liabilities arising from the findings in

the audit referenced as C I Number 07 5558 000

e DA VIS 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 DA VIS agrees to fully cooperate with any follow up reviews conducted by the

Agency

6 Payment shall be made to

AGENCY FOR HEAL THCARE 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 DA VIS agrees that failure to pay any monies due and owing under the terms of

this Agreement shall constitute DA VIS 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 DAVIS for any Medicaid claims

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

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DOAH Cases No 08 3219MPI and 08 3261RU

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Stipulation and Agreement

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 paragraph four 4 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 DAVIS agrees that AHCA may

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

referenced in paragraph four 4 above

11 DAVIS as its Provider Acknowledgment Statement Corrective Action Plan

acknowledges that

a To receive Medicaid reimbursement a provider must be enrolled in Medicaid

and meet all provider requirements at the time the service is rendered Every

entity that provides Medicaid services to recipients or billing services of any kind

to Medicaid providers must enroll as a Medicaid provider Specific qualifications

for each provider type are listed in service specific Coverage and Limitations

Handbooks These requirements are currently found in the Florida Medicaid

Provider General Handbook October 2003 page 2 2

b The Physicians Coverage and Limitations Handbook requires that if a physician

provider employs or contracts with any health care practitioner physician

physician assistant or advanced registered nurse practitioner who can enroll as a

Medicaid provider and that health care practitioner is treating Medicaid recipients

he or she must enroll as a Medicaid provider It also requires that two or more

Medicaid providers whose practice is incorporated under the same tax

identification number must enroll as a Medicaid provider group In order to

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DOAH Cases No 08 3219MPI and 08 3261RU

AHCA v Davis and Davis v AHCA

Stipulation and Agreement

receive payment from Medicaid each member of the group must also enroll as an

individual treating provider within the group

c Medicaid policy requires that the provider must retain all medical fiscal

professional and business records on all services provided to a Medicaid

recipient The records must be accessible legible and comprehensible Records

must be retained for a period of at least five years from the date of service and

must state the necessity for and the extent of the services provided These

requirements are currently found in the Florida Medicaid Provider General

Handbook dated October 2003 Prior to this time they were spelled out in the

Medicaid Provider Reimbursement Handbook HCFA 1500 and Child Health

Check Up Reimbursement Handbook

d Medicaid policy states that in order to qualify for reimbursement medical

records must be signed and dated at the time of the service The policy states that

the author of each medical record entry must be identified and must authenticate

his or her entry by signature written initials or computer entry These

requirements are currently found in the Florida Medicaid Provider General

Handbook dated October 2003

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 DA VIS agrees that its signature alone binds DAVIS to make the payment as set

forth in this agreement DA VIS shall furnish the actual signed Stipulation and Agreement to

AHCA however a facsimile copy shall be sufficient to enable AHCA to cancel a hearing

scheduled in this case

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DOAH Cases No 08 3219MPI and 08 3261RU

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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 DAVIS 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 DAVIS 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 DAVIS 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

DA VIS further agrees that the Agency should issue a Final Order which is consistent with the

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DOAH Cases No 08 3219MPI and 08 3261RU

AHCA v Davis and Davis v AHCA

Stipulation and Agreement

terms of this Stipulation and Agreement and which adopts this agreement and closes this matter

as to DOAH Case Number 08 3219MPI and Case Number 08 3261RU

17 DA VIS 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 3219MPI C No

07 5558 000 and DOAH Case Number 08 3261RU and AHCA 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

DA VIS

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

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DOAH Cases No 08 3219MPI and 08 3261RU

AHCA v Davis and Davis v AHCA

Stipulation and Agreement

RONALD G DAVIS M D and

PEDIATRIC NEUROLOGY P A

BY

Date L Jv b 2009

DEAN MEAD EGERTON BLOODWORTH

CAPOUANO BOZARTH P A

BY l

TRACY 1 MABRY ESQUIRE

Attorney for DAVIS

Date J 3 2009

Page 9 of 10

DOAH Cases No 08 3219MPI and 08 3261RU

AHCA v Davis and Davis v AHCA

Stipulation and Agreement

AGENCY FOR HEALTH CARE

ADMINISTRA nON

2727 Mahan Drive Mail Stop 3

Tallahassee FL 32308 5403

BY 2

PETER H WILLIAMS

Inspector General

Date I t l 2009

BY

M t2dfi

Jl 8TIN SvnOR

General Counsel

Date Gh or 2009

I

BY f 71 WCJ

DEBORA E FRIDIE

Assistant General Counsel

Date JUl le 9 2009

Page 10 of 10