12-000766 Coral Reef Operating Llc, D/B/A Coral Reef Nursing And Rehabilitation Center vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, March 16, 2012.

I..,. L Le

STATE STATE OF OF FLORIDA FLORIDA

AGENCY AGENCY FOR FOR HEALTH HEALTH CARE CARE ADMINISTRATION ADMINISTRATION

2014 2014 SEP SEP - -2 2 AID: A 10: 00 00

CORAL CORAL REEF REEF OPERATING, OPERATING, LLC, LLC,

d/b/a d/b/ a CORAL CORAL REEF REEF NURSING NURSING AND AND

REHABILITATIONCENTER, REHABILITATION CENTER,

Petitioner, Petitioner, ENGAGEMENT ENGAGEMENT NO.: NO.: NH06-160J NH06- 160J

PROVIDER PROVIDER NO.: NO.: 282529 282529

vs. Vs. RENDITION RENDITION NO.: NO.: AHCA- AHCA- ilf 14 - - 0755 07 JS - -S-MDA S- MDA

STATE STATE OF OF FLORIDA, FLORIDA, AGENCY AGENCY FOR FOR

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Respondent. Respondent.

----------------,/

FINAL FINAL ORDER ORDER

THIS THIS CAUSE CAUSE is is before before me me for for issuance issuance of of a a Final Final Order. Order. In In a a letter letter dated dated April April 4, 4, 2008, 2008,

Petitioner Petitioner was was informed informed that that the the State State of of Florida, Florida, Agency Agency for for Health Health Care Care Administration Administration

Agency) (Agency) had had completed completed an an examination examination of of Petitioner' Petitioner's s Medicaid Medicaid cost cost reports reports for for the the reporting reporting

period period specified specified in in the the letter. letter. The The letter letter consisted consisted of of an an examination examination report report that that notified notified

Petitioner Petitioner of of adjustments adjustments to to its its cost cost report report for for the the reporting reporting period period specified specified in in the the letter. letter.

Adjustments Adjustments to to the the cost cost report report impact impact the the rate rate of of Medicaid Medicaid payments payments to to Petitioner. Petitioner. A A retroactive retroactive

rate rate adjustment adjustment can can result result in in an an overpayment overpayment determination determination for for which which Petitioner Petitioner is is obligated obligated to to

repay. repay.

The The examination examination report report letter letter was was sent sent Certified Certified Mail, Mail, return return receipt receipt requested, requested, to to

Petitioner Petitioner at at theaddress the address last last shown shown on on the the provider provider enrollment enrollment file. file. The The letter letter contained contained full full

disclosure disclosure and and notice notice regarding regarding Petitioner' Petitioner's s administrative administrative hearing hearing and and due due process process rights. rights.

Petitioner Petitioner requested requested a a hearing hearing to to dispute dispute the the facts facts contained contained in in the the letter. letter.

FINDINGS FINDINGS OF OF FACT FACT

1. 1. Petitioner Petitioner was was provided provided notice notice of of the the examination examination adjustments adjustments as as set set forth forth in in the the

examination examination report report letter. letter.

2. 2. The The examination examination report report letter letter disclosed disclosed the the Petitioner' Petitioner's s administrative administrative and and due due

process process rights. rights.

3. 3. Petitioner Petitioner agrees agrees to to all all audit audit readjustments readjustments as as set set forth forth in in the the settlement settlement

agreement. agreement.

CONCLUSIONS OF LAW

4. The Agency incorporates and adopts the statements and conclusions of law as set

forth in the examination report letter.

5. The admitted facts support the conclusion that the cost report adjustments are true

and accurate and form the basis for any corresponding rate adjustments.

6. Petitioner is advised that the rate adjustments will be assessed immediately and

any overpayments which resulted are due and owing to the Agency. Notice of the rate

adjustment and any overpayments which resulted from the retroactive rate adjustment have been

conveyed to Petitioner. At that time, Petitioner is obligated to repay the overpayments or make

satisfactory arrangements with the Agency.

7. Petitioner is also advised that pursuant to Section 409.913(l5)(k), Florida

Statutes, the Agency is required to apply an administrative sanction where a subsequent cost

report includes a cost that is not allowable under a Florida Title XIX reimbursement plan, after

having beenadvised that the costs were not allowable; therefore, Petitioner is advised that any

costs that were disallowed by way of the examination report letter on the basis that the cost is not

allowable under a Florida Title XIX reimbursement plan are prohibited in any future cost report.

ORDER

BASED on the foregoing, it is ORDERED and ADJUDGED that the Petitioner's cost

reports be adjusted as set forth in the attached Settlement Agreement, that the Agency recalculate

the Medicaid reimbursement rate, and that any retroactive rate adjustment which results in an

overpayment is now due and owing to the Agency, together with such statutory interest as is set

forth in the Florida Statutes. In the event the Petitioner was underpaid, the Agency will pay

Petitioner the full amount within forty-five (45) days of notice of recalculation. Where it is

determinedthat Petitioner was overpaid, the Petitioner will reimburse the Agency the full

amount of the overpayment within thirty (30) days of the notice of recalculation.

DONE AND ORDERED this 2 r fA day of f/t,/fJUJI ,2014, in Tallahassee, Leon

J

County, Florida.

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:

Claudia E. Reingruber, CPA

Reingruber & Company, P.A.

100 Second Avenue South,Suite 300-S

St. Petersburg, Florida 33701-4360

(U.S. mail)

Beverly H. Smith

Assistant General Counsel

Mercedes Bosque, Acting Audit Administrator

(Interoffice mail)

Finance & Accounting

(Interoffice mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been served on

the persons by Electronic Mail/U.S. Mail or interoffice mail as indicated on this

the.z:::aayof 2014.

Richard Shoop, Agency

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5403

[phone]