12-001058 Agency For Health Care Administration vs. Gladys Bryant Lamb, D/B/A Gladys Bryant Lamb Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, May 24, 2012.

NOTICE OF RIGHT TO JUDICIAL REVIEW

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO

JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF

APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY, ALONG WITH THE FILING

FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the fore g Final Order has been

furnished by U. S. or interoffice mail to the persons named below on this Sy of

2012.

RICHARD TS- HOOP, Agency

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, FL 32308

850) 412- 3630

COPIES FURNISHED TO:

Rachic' Wilson, Esquire

Informal Hearing Officer

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, FL 32308

Willis F. Melvin, Jr., Esquire

Assistant General Counsel

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, FL 32308

Gladys Girtman

719 South Boundary Avenue

Deland, Florida 32720

Medicaid Program Integrity

Office of the Inspector General

Henry Evans

Finance & Accounting

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, y;

Case No.: 11- 763PH

v. Provider No.: 00074530w

C. I. No.: 12- 000 0358- p

GLADYS M. GIRTMAN, c- n

Respondent.

AMENDED RECOMMENDED ORDER

Pursuant to Notice, a final hearing was held in this case in accordance with section

120. 2), 572( Florida Statutes, on April 3, 2012, before Rachic' Wilson, a duly designated Informal

Hearing Officer of the Agency for Health Care Administration.

APPEARANCES

For Petitioner: Willis Melvin, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Building 3

Tallahassee, Florida 32308

For Petitioner: Gladys Girtman

719 South Boundary Avenue

Deland, Florida 32720

STATEMENT OF ISSUES

I . Whether Respondent was properly fined $ 2, 00 500. and suspended from participation in

the Medicaid program for failure to timely respond to a Demand Letter.

EXHIBITS

Petitioner' s Exhibit I Demand Letter dated July 18, 2011

Petitioner' s Exhibit 2 Sanction Letter dated August 23, 2011.

WITNESSES

1. Victor Rivera, Investigator

Agency for Health Care Administration

400 West Robinson Street, Suite S309

Orlando, Florida 32801

2. Gladys Girtman

710 South Boundary Avenue

Deland, Florida 32720

FINDINGS OF FACT

1. On July 18, 2011, the Agency sent a Demand Letter via certified mail to Respondent.

The letter put Respondent on notice that certain records should be provided to the Agency within

fifteen ( 15) calendar days of Respondent' s receipt of the letter.

2. A notice regarding the Demand Letter was left at Respondent' s residence by the United

States Postal Service on July 22, 2011.

3. The Demand Letter was classified by the United States Postal Service as unclaimed on

August 8, 2011.

4. The Demand Letter was returned to the Agency as undeliverable on August 15, 2011.

5. On August 23, 2011, a Sanction Letter was issued requiring Respondent to pay the

Agency a fine of $ 2, 00 500. for violations of section 409. e), 913( Florida Statutes.

6. Respondent admitted to the fact that the records were not furnished within the prescribed

time period.

CONCLUSIONS OF LAW

1. The Agency for Health Care Administration has jurisdiction over the parties to, and to the

subject matter of, these proceedings, under section 120. 2), 57( Florida Statutes.

2. Pursuant to section 409. 902, Florida Statutes, Petitioner is charged with overseeing and

administering the Medicaid program in the state of Florida.

3. Section 409. 15), 913( Florida Statutes states, in pertinent part, that:

The Agency shall seek a remedy provided by law, including but not limited to, any

remedy provided in subsections ( 13) and ( 16) and s. 035 812. if:

e) The Provider has not furnished or has failed to make available such

Medicaid- related records as the agency has found necessary to determine

whether Medicaid payments are or were due and the amounts thereof..."

4. Rule 59G- 070( 9. 7), Florida Administrative Code, states in pertinent part:

SANCTIONS: In addition to the recoupment of the overpayment, if any, the Agency

will impose sanctions as outlined in this subsection. Except when the Secretary of the

Agency determines not to impose a sanction, pursuant to Section 409. 16) 913( 0), F. S.,

sanctions shall be imposed as follows:

c) For failure to make available or furnish all Medicaid- related records, to be

used in determining whether and what amount should have or should be

reimbursed: For a first offense, $ 2, 500 fine per record request and

suspension until the records are made available... and, if after 30 days the

violation remains ongoing, termination..."

5. The July 18, 2011, Demand Letter states " the Medicaid- related records to substantiate

billing for the recipients identified on the enclosed printout are due within fifteen ( 15) calendar

days of your receipt of this notification."

6. Respondent to date has not submitted the requested records.

7. Therefore, as set forth in the proposed findings of fact above, the Agency succeeded in

establishing that Respondent failed to furnish records within the prescribed timeframe.

8. As such, the Agency properly fined Respondent $ 2, 00 500. and suspended Respondent

from participation in the Medicaid program.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that

the Agency for Health Care Administration enter an Order requiring that Respondent pay an

administrative fine of two thousand five hundred dollars ($ 2, 500) and suspending Respondent

from participation in the Medicaid program.

DONE AND ENTERED this 0(- XL day of May, 2012.

AGENCY FOR HEALTH CARE

ADM

BY: T LLCI 16 M

Rachic' A. Wilson, Esquire

Informal Hearing Officer

Agency for Healthcare Administration

2727 Mahan Drive, Mail Stop # 3

Tallahassee, Florida 32308

Copies to:

Willis Melvin, Esquire

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, Florida 32308

Gladys Girtman

710 South Boundary Avenue

Deland, Florida 32720

Richard J. Shoop

Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, Florida 32308