09-006165MPI Agency For Health Care Administration vs. Lynk Services, Inc. Status: Closed Recommended Order on Tuesday, April 6, 2010.

Summary: Respondent is liable for overpayment where authorized services were billed but not provided to waiver recipient.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Petitioner, )

)

vs. ) Case No. 09-6165MPI

)

LYNK SERVICES, INC., )

)

Respondent. )

)

RECOMMENDED ORDER

On February 8, 2010, a formal administrative hearing in

this case was held in Tallahassee, Florida, before William F.

Quattlebaum, Administrative Law Judge, Division of

Administrative Hearings.

APPEARANCES

For Petitioner: Andrew T. Sheeran, Esquire

Agency for Health Care Administration

Fort Knox Building, Mail Stop 3

2727 Mahan Drive, Suite 3431

Tallahassee, Florida 32308

For Respondent: Lynne Ballou, CEO, WSC

Qualified Representative

Lynk Services, Inc.

2189 Cleveland Street, Suite 207

Clearwater, Florida 33765

STATEMENT OF THE ISSUES

The issues in the case are whether Lynk Services, Inc.

(Respondent), violated applicable provisions of the Florida

Administrative Code, and, if so, what penalty should be imposed.

PRELIMINARY STATEMENT

By letter dated October 2, 2009, the Agency for Health Care

Administration (Petitioner) alleged that the Respondent violated

Florida Administrative Code Rule 59G-9.070(7)(f). As stated in

the letter, the Petitioner sought to impose a $1,000 fine and to

require compliance with a corrective action plan to address the

violation.

The Respondent disputed the alleged violation and penalty

and requested a hearing. The Petitioner forwarded the request

to the Division of Administrative Hearings, which scheduled and

conducted the proceeding.

At the hearing, the Petitioner presented the testimony of

one witness and had one composite exhibit admitted into

evidence. The Respondent presented the testimony of one

witness.

No transcript of the hearing was filed. The Petitioner

filed a Proposed Recommended Order on March 10, 2009, pursuant

to the schedule adopted at the hearing.

FINDINGS OF FACT

1. The Florida Medicaid Developmental Disabilities Waiver

Program (Waiver) provides approved health and personal services

to qualified recipients. The Agency for Persons with

Disabilities (APD) administers the Waiver and conducts audits of

participating health care providers.

2. The time period relevant to this case (the "audit

period") was April 1, 2006, through June 30, 2006.

3. At all times material to this case, the Respondent was

the Waiver Support Coordinator (WSC) for Waiver recipient R.M.

4. At all times material to this case, Premier Health Care

(Premier) was the personal care assistance provider assigned by

the Respondent to R.M.

5. On March 31, 2006, the Respondent filed with APD, an

authorization for personal care services to be provided to R.M.

by Premier for the one-year period commencing on April 1, 2006.

6. Premier filed claims for the provision of personal care

service to R.M. during at least part of the audit period. The

Florida Medicaid program paid the claims.

7. Premier did not provide personal care assistance to

R.M. during the audit period.

8. The only service provided to R.M. during the audit

period by a Premier employee was supervision of oxygen usage,

which is not a personal care service.

9. The Respondent did not file any request to amend the

service authorization to reflect the services actually provided

by Premier to R.M.

10. An overpayment of $2,006.00 occurred, based on payment

by APD for personal care services that were not provided to R.M.

CONCLUSIONS OF LAW

11. The Division of Administrative Hearings has

jurisdiction over the parties to and subject matter of this

proceeding. §§ 120.569 and 120.57(1), Fla. Stat. (2009).

12. The Petitioner has the burden of proving by a

preponderance of the evidence the overpayments for which it

seeks reimbursement. Southpointe Pharmacy v. Department of

Health and Rehabilitative Services , 596 So. 2d 106 (Fla. 1st DCA

1992). In this case, the burden has been met.

13. The Florida Medicaid Developmental Disabilities Waiver

Services Coverage and Limitations Handbook (Handbook) governs

the operation of the Waiver.

14. The Handbook assigns responsibility to the WSC for

managing the provision of personal care assistance to a Waiver

recipient by a provider. Handbook page 2-60 requires that the

WSC monitor the provision of personal care services by a

provider to a Waiver recipient and to request changes to the

applicable care plan to increase or decrease services as

appropriate.

15. Handbook page 2-92 requires that the WSC review

documentation and monitor services to determine whether such

services meet the recipient's expectations. Handbook page 2-93

requires that within five days of becoming aware that a

recipient's needs have changed, the WSC must update the cost

plan to reflect the recipient's current need for services.

16. Handbook page 3-4 states that reimbursement for

services not delivered is considered overpayment and is subject

to action by the Petitioner to recoup the disbursed funds.

17. In this case, the Respondent failed to monitor the

provision of personal care services by Premier to R.M. The

Respondent further failed to request appropriate changes to

R.M.'s care plan to delete the authorization for personal care

services that were not provided. The payment of funds during

the audit period for personal care assistance to R.M. was an

overpayment because the services were not delivered to R.M. by

Premier.

18. Florida Administrative Code Rule 59G-9.070(7)(f)

provides, in relevant part, as follows:

(7) SANCTIONS: Except when the Secretary

of the Agency determines not to impose a

sanction, pursuant to Section

409.913(16)(j), F.S., sanctions shall be

imposed for the following:

* * *

(f) Furnishing or ordering goods or

services that are inappropriate or

unnecessary because they are out of

compliance with the practice standards

governing the provider’s profession, are

excessive, of inferior quality, or that are

found to be harmful to the recipient.

[Section 409.913(15)(f), F.S.];

19. Pursuant to Florida Administrative Code Rule 59G-

9.070(10)(i), the appropriate penalty applicable to this case is

a fine of $1,000 and the submission of a corrective action plan.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that the Agency for Health Care

Administration enter a final order stating that the Respondent

violated applicable requirements as set forth herein and

assessing a fine of $1,000 and requiring the submission of an

acceptable corrective action plan.

DONE AND ENTERED this 6th day of April, 2010, in

Tallahassee, Leon County, Florida.

S

WILLIAM F. QUATTLEBAUM

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone]

Fax Filing [phone]

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 6th day of April, 2010.

COPIES FURNISHED :

Lynne Ballou, CEO, WSC

Lynk Services, Inc.

2189 Cleveland Street, Suite 207

Clearwater, Florida 33765

Andrew T. Sheeran, Esquire

Agency for Health Care Administration

Fort Knox Building, Mail Stop 3

2727 Mahan Drive, Suite 3431

Tallahassee, Florida 32308

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Justin Senior, General Counsel

Agency for Health Care Administration

Fort Knox Building, Suite 3431

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Thomas W. Arnold, Secretary

Agency for Health Care Administration

Fort Knox Building, Suite 3116

2727 Mahan Drive

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.