11-005089MPI Agency For Health Care Administration vs. Hillsborough Association For Retarded Citizens, Inc. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, January 25, 2012.

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:

Jeffries H. Duvall

Assistant General Counsel

Agency for Health Care Administration

Office of the General Counsel

Interoffice)

CYNTHIA A. MIKOS, ESQ.

Allen Dell, P. A.

202 S. Rome Ave. - Suite 100

Tampa, FL 33606

cmikosn_, allendell. com

Electronic Mail)

J. D. Parrish

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399- 3060

Mike Blackburn, Bureau Chief, Medicaid Program Integrity

Finance and Accounting

Health Quality Assurance ( via email)

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, Laserfiche or electronic mail on this the ?$ d- ay of

2012.

Richard Shoop, Esquire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, Florida 32308- 5403

850) 412- FAX ( 3630/ 850) 921- 0158

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

vs. CASE NO. 11 - 5089MPI

C. I. NO. 11- 000 1553-

HILLSBOROUGH ASSOCIATION FOR

RETARDED CITIZENS, INC.,

Respondent.

SETTLEMENT AGREEMENT

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

AHCA" or " the Agency"), and Hillsborough Association for Retarded Citizens, Inc.

PROVIDER"), by and through the undersigned, hereby stipulate and agree as follows:

1. The two parties enter into this agreement to memorialize the resolution of this

matter.

2. PROVIDER is a Florida Medicaid provider, provider number 024102498 and was

a provider during the audit period, January 1, 2009 to December 31, 2009.

3. In its Final Agency Audit Report ( constituting final agency action) dated

September 2, 2011, AHCA notified PROVIDER that review of Medicaid claims by the Division

of Medicaid, Office of the Deputy Secretary, and Medicaid Program Integrity ( MPI), Office of

the AHCA Inspector General, indicated certain claims, in whole or in part, had been

inappropriately paid. The Agency sought recoupment of this overpayment in the amount of

34, 55. 317. In response, PROVIDER filed a petition for formal administrative hearing. It was

assigned DOAH Case No. 11- 5089MPI.

Hillsborough Association for Retarded Citizens, Inc.

C. 1. 11- 000 - 1553- Settlement Agreement

4. Subsequent to the original audit, in preparation for trial, AHCA re- reviewed the

PROVIDER' s claims and evaluated additional documentation submitted by the PROVIDER. As

a result of the additional review, AHCA determined the overpayment should be adjusted to

27, 51, 078. plus $ 5, 70 415. in fines and $ 674. 38 in costs for a total due of $ 33, 59. 168.

5. In order to resolve this matter without further administrative proceedings,

PROVIDER and the AHCA agree as follows:

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

overpayment issues arising from the captioned audit.

2) The amount in dispute that is now being resolved is twenty- seven thousand

seventy eight dollars and fifty- one cents ($ 27, 51) 078. on the indebtedness, five

thousand four hundred fifteen dollars and seventy cents ($ 5, 70) 415. in fines, plus

six hundred seventy four dollars and thirty- eight cents ($ 674. 38) in investigative

costs for a total of thirty three thousand one hundred sixty eight dollars and fifty-

nine cents ($ 33, 59). 168. PROVIDER will make an initial payment of eight

thousand dollars ($ 8, 000) and the remaining balance to be paid in 6 equal monthly

installments. This amount due will be offset by any amount already received by

the Agency in this matter. Furthermore, PROVIDER is advised that pursuant to

Section 409. 913, Florida Statutes, failure to pay in full, or enter into and abide by

the terms of any repayment schedule set forth by the Agency may result in

termination from the Medicaid program, withholding of future Medicaid

payments, or other such remedies as provided by law. Any outstanding balance

accrues at 10% interest per year. Full payment will fully and completely settle all

claims in these proceedings before the Division of Administrative Hearings

Hillsborough Association for Retarded Citizens, Inc.

C. 1. 11- 000 - 1553- Settlement Agreement

DOAH Case No. 11- 5089MPI). Should the provider' s enrollment with Medicaid

be terminated, the full amount owed will be due within 30 days of termination.

3) In the event any interim payments are received or withheld, by whatever

means, prior to the entry of the Final Order, Medicaid Accounts Receivable shall

make the adjustment to credit such amounts, dollar for dollar, as quickly as is

practicable.

4) Compliance with this repayment agreement fully and completely settles all

claims in these proceedings before the Division of Administrative Hearings

DOAH Case No. 11- 5089MPI). Should the provider' s enrollment with Medicaid

be terminated, the full amount owed will be due within 30 days of termination.

5) PROVIDER and AHCA agree that full payment, as set forth above,

resolves and settles this case completely. It will release both parties from any

administrative or civil liabilities or claims arising from the findings in audit C. I.

11- 000. 1553-

6) 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.

6. Questions regarding procedures for submitting payment should be directed to

Medicaid Accounts Receivable, ( 850) 412- 3901. The C. I. number listed on the first page of this

agreement must be legibly entered on the check to assure proper credit. Please mail payment to:

AGENCY FOR HEALTHCARE ADMINISTRATION

Medicaid Accounts Receivable - MS # 14

2727 Mahan Drive, Bldg. 2, Suite 200

Tallahassee, Florida 32308

Hillsborough Association for Retarded Citizens, Inc.

C. 1. 11- 000 - 1553- Settlement Agreement

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, with the exception that the

Respondent shall reimburse, as part of this settlement, $ 674. 38 in Agency costs and $ 5, 70 415. in

fines. This amount is included in the calculations and demand of paragraph 5( 2).

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

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.

Hillsborough Association for Retarded Citizens, Inc.

C. 1. 11- 000 - 1553- 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.

Hillsborough Association for Retarded Citizens, Inc.

C. 1. 11- 000 - 1553- Settlement Agreement

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

parties in counterpart.

HILLS ROUGH A SOCIATION FOR RETARDED CITIZENS, INC.

Dated: 2012

BY:

Print name)

ITS: ! 2J2~ f / c° Jn1li

AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive, Mail Stop 43

Tallahassee, FL 32308- 5403

Dated: 2012

Miller

Inspector General

Dated: 2012

William H. Roberts

Acting General Coun

Dated: 2 2012

J es Duvall

si ant General Counsel