08-004579MPI Agency For Health Care Administration vs. Osprey Emergency Physicians Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, June 18, 2009.

W

STATE OF FLORIDA r ll Lt U

DIVISION OF ADMINISTRATIVE HEARINGS AHC

AGENCY CLERK

ZOOq SEP lOP 2

STATE OF FLORIDA AGENCY FOR 0 1

HEALTH CARE ADMINISTRATION

Petitioner

DOAH Case No 08 4579MPI

vs PROVIDER NO 25948626 00

AHCA C I No 07 5911 000

OSPREY EMERGENCY PHYSICIANS RENDITION NO AHCA 09 f O pt S MDO

Respondent

AMENDED 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 01 of

n day 5yd 2009 in

Tallahassee Florida

ft

Holly Benson Secretary r

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 mail or tr C c r

by interoffice mail this 10 day of

7

2009

Richard Shoop Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Bldg 3 Mail Stop 3

Tallahassee Florida 32308 5403

850 922 5873

STATE OF FLORIDA

DNISION OF ADMINISTRATNE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs CASE NO 08 4579MPI

C NO 07 5911 000

OSPREY EMERGENCY PHYSICIANS

Respondent

I

SETTLEMENT AGREEMENT

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

AHCA or the Agency and OSPREY EMERGENCY PHYSICIANS 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

2594862 00 and was a provider during the audit period

3 In its Final Audit Report final agency action dated August 8 2008 AHCA

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

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

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

overpayment in the amount of 24 574 79 plus a fine in the amount of 1 500 00 for violation s

of Rule Section 59G 9 070 7 c and e F A C In response to the audit letter dated August 8

2008 PROVIDER filed a petition for a formal administrative hearing which was assigned

Osprey Emergency Physicians

Settlement Agreement

DOAH Case No 08 4579MPI

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 11 712 43

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 pay

the Agency fourteen thousand two hundred twelve dollars and forty three

cents 14 212 43 which includes 2 500 in fines and costs in one lump

sum PROVIDER 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 I 07 5911

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

1

Osprey Emergency Physicians

Settlement Agreement

6 Payment shall be made to

AGENCY FOR HEALTHCARE 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 County Florida

13 This Agreement constitutes the entire agreement between PROVIDER and the

AHCA including anyone acting for associated with or em ployed 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

Osprey Emergency Physicians

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 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

16 This Agreement is and shall be deemed jointly drafted and written all to

by parties

it and shall not be construed or interpreted against the party originating or it

preparing

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

Osprey Emergency Physicians

Settlement Agreement

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

respective

parties in counterpart

OSPREY EMERGENCY PHYSICIANS

Dated II I 2009

Print name

ITS jI T nItN6 1 IN Pifer

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive Mail Stop 3

Tallahassee FL 32308 5403

v L Dated

1 2009

Pet Williams Iti

Inspector General

k Dated 8 24 2009

Jultin M Sc t 6r

Acting General Counsel

Dated WU 2009

tl

Corrective Action Plan Acknowlede ement Statement

A corrective action plan is the process or plan by which the provider will ensure

future compliance with state and federal Medicaid laws rules provisions handbooks

and policies For purposes of this matter the sanction of a corrective action plan shall

take the form of an acknowledgement statement which is a written document

submitted to the Agency for Health Care Administration Agency within 30 days of the

date of the Agency action that brought rise to this requirement An acknowledgement

statement identifies the areas of non compliance as determined by the Agency in this

Final Audit Report FAR acknowledges a requirement to adhere to the specific state and

federal Medicaid laws rules provisions handbooks and policies that are at issue in the

FAR and must be signed by the provider or its president director or owner

The acknowledgement statement is due to Office of Inspector General Medicaid

Program Integrity within 30 days of the issuance of this FAR Please sign the enclosed

statement and return it to

Jill Smith Investigator

Agency for Health Care Administration

Office of Inspector General

Medicaid Program Integrity

2727 Mahan Drive Mail Stop 6

Tallahassee FL 32308 5403

Phone [phone]

Facsimile 850 410 1972

Failure to comply with the requirements set forth above may result in the imposition

of additional sanctions which may include monetary fines suspension or termination

from the Medicaid program

ElnCare

Received

2008

E

Compliance Dept

Corrective action plan Acknowledgement Statement

Final Agency Audit Report August 8 2008

c 07 5911 000

PROVIDER ACKNOWLEDGEMENT STATEMENT

I j A e L It P l on behalf of Osprey Emergency Physicians

insert printed full name here

a Medicaid provider operating under provider number 2594862 00 do hereby

acknowledge the obligation of Osprey Emergency Physicians to adhere to state and

federal Medicaid laws rules provisions handbooks and policies Additionally Osprey

Emergency Physicians acknowledges that Medicaid policy requires

Medicaid policy defines the varying levels of care and expertise required for the

evaluation and management procedure codes for office visits Medicaid uses the

Physician s Current Procedure Terminology CPD book which contains

complete descriptions of the standard codes Medical records must state the

necessity for and extent of serVices provided The following requirements may

vary according to the service rendered history physical assessment chief

complaint on each visit diagnostic test and results diagnosis treatment plan

including prescriptions medications supplies scheduling frequency for follow

up or other services progress reports treatment rendered the author of each

medical record entry must be identified and must authenticate his or her entry by

signature written initials or computer entry dates of service and referrals to

other services

By Date 41

s ature

title fl1 AI Y IN rJf r

Return completed acknowledgement statement to Office of Inspector General

Medicaid Program Integrity

Corrective action plan Acknowledgement Statement

Final Agency Audit Report August 8 2008

CJ 07 5911 000

f t 1 U Ii I 0

M1CA

AGENCY CLER1

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATIdiq AUG 31 P I 18

STATE OF FLORIDA AGENCY FOR

HEALTH CARE ADMINISTRATION

Petitioner

vs DOAH Case No 08 4579MPI

PROVIDER NO 2594862 00

RENDITION NO AHCA 09 B3u S MDO

OSPREY EMERGENCY PHYSICIANS

Respondent

FINAL ORDER

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

is attached and incorporated by reference The parties are directed to comply with the terms of

the attached repayment agreement Based on the foregoing this case is CLOSED

DONE AND ORDERED this 6 rJ day of f v 2009 in Tallahassee

r

Florida

cf L

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 MUSTBE 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 y of C

1

2009

J

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION

Petitioner

vs CASE NO 08 4579MPI

C I NO 07 5911 000

OSPREY EMERGENCY PHYSICIANS

Respondent

SETTLEMENT AGREEMENT

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

AHCA or the Agency and OSPREY EMERGENCY PHYSICIANS 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

2594862 00 and was a provider during the audit period

3 In its Final Audit Report final agency action dated August 8 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 sought recoupment of this

overpayment in the amount of 24 574 79 plus a fine in the amount of I 500 00 for violation s

of Rule Section 59G 9 070 7 c and e F A C In response to the audit letter dated August 8

2008 PROVIDER filed a petition for a formal administrative hearing which was assigned

Osprey Emergency Physicians

Settlement Agreement

DOAH Case No 08 4579MPI

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 11 712 43

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 pay

the Agency fourteen thousand two hundred twelve dollars and forty three

cents 14 212 43 which includes 2 500 in fines and costs in one lump

sum PROVIDER 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 I 07 5911

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 ofthe audit in this case

Osprey Emergency Physicians

Settlement Agreement

6 Payment shall be made to

AGENCY FOR HEALTHCARE ADMINISTRATION

Medicaid Accounts Receivable

Post Office Box 13 749

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 County Florida

13 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

Osprey Emergency Physicians

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

Osprey Emergency Physicians

Settlement Agreement

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

parties in counterpart

OSPREY EMERGENCY PHYSICIANS

i Dated If 2009

BY T1lfH8t l A1 Jf IIY

Print name

ITS JtNet IN rA r

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive Mail Stop 3

Tallahassee FL 32308 5403

Dated 1 2009

Petf lli

Inspector General

k Dated 3 2 4 2009

Jultin M Se66r

Acting General Counsel

Dated pit 1 1 wJ 2009

t

1

Corrective Action Plan Acknowlede ement Statement

A corrective action plan is the process or plan by which the provider will ensure

future compliance with state and federal Medicaid laws rules provisions handbooks

and policies For purposes of this matter the sanction of a corrective action plan shall

take the form of an acknowledgement statement which is a written document

submitted to the Agency for Health Care Administration Agency within 30 days of the

date of the Agency action that brought rise to this requirement An acknowledgement

statement identifies the areas of non compliance as determined by the Agency in this

Final Audit Report FAR acknowledges a requirement to adhere to the specific state and

federal Medicaid laws rules provisions handbooks and policies that are at issue in the

FAR and must be signed by the provider or its president director or owner

The acknowledgement statement is due to Office of Inspector General Medicaid

Program Integrity within 30 days of the issuance of this FAR Please sign the enclosed

statement and return it to

Jill Smith Investigator

Agency for Health Care Administration

Office of Inspector General

Medicaid Program Integrity

2727 Mahan Drive Mail Stop 6

Tallahassee FL 32308 5403

Phone [phone]

Facsimile 850 410 1972

Failure to comply with the requirements set forth above may result in the imposition

of additional sanctions which may include monetary fines suspension or termination

from the Medicaid program

EmCare

Received

008l

L Compliance Dept

Corrective action plan Acknowledgement Statement

Final Agency Audit Report August 8 2008

c I 07 5911 000

PROVIDER ACKNOWLEDGEMENT STATEMENT

I JAtlJE L IH t P l on behalf of Osprey Emergency Physicians

insert printed full name here

a Medicaid provider operating under provider number 2594862 00 do hereby

acknowledge the obligation of Osprey Emergency Physicians to adhere to state and

federal Medicaid laws rules provisions handbooks and policies Additionally Osprey

Emergency Physicians acknowledges that Medicaid policy requires

Medicaid policy defines the varying levels of care and expertise required for the

evaluation and management procedure codes for office visits Medicaid uses the

Physician s Current Procedure Terminology CPT book which contains the

complete descriptions of the standard codes Medical records must state

necessity for and extent of services provided The following requirements may

vary according to the service rendered history physical assessment chief

complaint on each visit diagnostic test and results diagnosis treatment plan

including prescriptions medications supplies scheduling frequency for follow

up or other services progress reports treatment rendered the author of each

medical record entry must be identified and must authenticate his or her entry by

signature written initials or computer entry dates of service and referrals to

other services

By Date OI 44J

s

title Jf1 AI Y IN rlf

Return completed acknowledgement statement to Office of Inspector General

Medicaid Program Integrity

Corrective action plan Acknowledgement Statement

Final Agency Audit Report August 8 2008

C 07 5911 000