12-001447MPI Agency For Health Care Administration vs. Bay Regional And International Institute Of Neurology/Dr. Radhakrishna Rao Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, May 4, 2016.

Summary: Petitioner established that Respondent billings to Medicaid resulted in "overpayments."

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION,

Petitioner,

vs. Case No. 12 - 1447MPI

BAY REGIONAL AND INTERNATIONAL

INSTITUTE OF NEUROLOGY/

DR. RADHAKRISHNA RAO,

Respondent.

_______________________________/

RECOMMENDED ORDER

On December 16 through 18, 2013, an administrative hearing

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

Quattlebaum, Administrative Law Judge, Division of Administrative

Hearings.

APPEARANCES

For Petitioner: Karen A. Brodeen, Esquire

Robert A. Milne, Esquire

Office of the Attorney General

The Capitol , Plaza Level 01

Tallahassee, Florida 32399 - 1050

For Respondent: F rank P. Rainer, Esquire

Broad and Cassel

Sui te 400

215 South Monroe Street

Tallahassee, Florida 3230 1 - 1804

STATEMENT OF THE ISSUE S

Whether the Bay Regional and International Institute of

Neurology/Dr. Radhakrishna Rao (Respondent) received Medicaid

overpayments that the Agency for Healt h Care Administration,

Office of Inspector General, Bureau of Medicaid Program Integrity

( Petitioner), is entitled to recover , and whether a fine should be

imposed against Respondent.

PRELIMINARY STATEMENT

By Final Audit Report (FAR) dated June 1, 2011, th e

Petitioner asserted that the Respondent, a Medicaid provider, had

received an overpayment of $110,712.09 for charges filed by the

Respondent with the Medicaid program. The FAR stated that the

Petitioner intended to seek repayment of the alleged overpaym ent,

to impose an administrative fine of $24,642.42 and to assess

costs of $7,336.12.

By letter dated June 20, 2011, the Respondent disputed the

alleged overpayment and requested a formal administrative

hearing. The Petitioner forwarded the request to t he Division

of Administrative Hearings (DOAH), where it was designated as

DOAH Case No. 11 - 3313MPI and assigned to Administrative Law

Judge ( ALJ) J.D. Parrish. An administrative hearing was

scheduled for October 3 and 4, 2011.

On September 6, 2011, the parties filed a Joint Motion to

Relinquish Jurisdiction to permit the parties to pursue a

resolution of the dispute. ALJ Parrish granted the motion in an

Order dated September 16, 2011, and the DOAH file was closed.

On April 10, 2012, the Petitioner fil ed a Motion to Reopen

the case. The Motion was granted by ALJ Parrish , and the case

was reopened as DOAH Case No. 12 - 1447MPI. An administrative

hearing was scheduled for July 2 and 3, 2012. For a variety of

reasons, the hearing was continued and resched uled before it

eventually commenced on December 16, 2013.

The case was transferred to the undersigned ALJ on

December 9, 2013.

At the hearing, the Petitioner presented the testimony of

Fred Becknell, Jennifer Ellingsen, Blanca Notman, Dr. Fred Huffer

a nd Dr. Harry Abram. Official recognition was taken of relevant

statutes, rules and documents identified as Petitioner's Exhibits

A through C, K and L. The Petitioner's Exhibits E through J

(pages 403 through 409 only), N, P and Q were admitted into

evide nce. The Respondent testified on his own behalf and

presented the deposition testimony of Dr. Jose Foradada. The

Respondent's Exhibits 5, 6, 9, 10, 17, 24 and 25 were admitted

into evidence.

Volume I of the Transcript of the hearing was filed on

Januar y 10, 2014. Volumes II through VI of the Transcript were

filed on January 14, 2014.

On February 25, 2014, the parties filed proposed recommended

orders that have been considered in the preparation of this

Recommended Order.

The Petitioner's Proposed R ecommended Order states that the

Respondent failed to file the deposition testimony of Dr. Jose

Foradada. The transcript of a deposition of Dr. Foradada taken

on October 22, 2013, was included in the materials filed with

DOAH prior to the hearing and was transferred to the undersigned

ALJ as part of the case file on December 9, 2013.

The Respondent's Proposed Recommended Order includes

Proposed Findings of Fact related to charges dated 7/25/08 , for a

patient identified as Recipient No. 8. At the hearing , the

Petitioner stipulated that the disallowance of the charge had

been withdrawn and that it was no longer considered to be an

overpayment.

For reasons unknown, the Respondent in this case has been

identified as Bay Regional and International Institute of

Neurology/Dr. Radhakrishna Rao. There is no evidence that anyone

other than Dr. Rao was involved in the provision of medical

treatment relevant to this proceeding. References in this

Recommended Order to the Respondent are to Dr. Rao unless

otherwise specified.

When this dispute was initially referred to DOAH in 2011,

the Petitioner was seeking to impose a fine of $24,642.42. At

the commencement of the hearing, the Petitioner announced that

the proposed fine had been incorrectly calculated and that , based

on the rules in effect during the audit period, the Petitioner

was seeking to impose a fine of $3,500. Thereafter, the parties

recessed to discuss remaining factual disputes, a substantial

number of which were resolved at that time or during the h earing.

This Recommended Order addresses only the charges that remained

in dispute at the conclusion of the hearing.

FINDING S OF FACT

1. The Medicaid program (Medicaid) is a federal and state

partnership that funds health care services for qualified

indi viduals.

2. The Petitioner is the state agency charged with

administering the provisions of Medicaid in Florida.

3. The Respondent owns and operates the Bay Regional and

International Institution of Neurology. At all times material to

this case, the Respondent was a duly - licensed Florida physician

who participated as a provider in Medicaid pursuant to a Medicaid

Provider Agreement executed between himself and the Petitioner.

4. The Respondent specializes in neurology and pediatric

neurology. Many of the Respondent's patients are medically

complex developmentally disabled persons with neurological

issues. A portion of his practice serves patients who receive

services through enrollment in Children's Medical Services

Network (CMS) or who have "aged out" of CMS and remain as the

Respondent's patients.

5. The Petitioner is legally authorized to monitor the

activities of Medicaid providers and to recover "overpayments."

Overpayments include reimbursement for services that are not

medically necessar y, as verified by records existing at the time

of service.

6. The Petitioner's Bureau of Medicaid Program Integrity

(MPI) routinely audits provider s .

7. The Petitioner was authorized by section 409.9131(5)(a) ,

Florida Statutes (201 0 ), 1/ to use a vari ety of "accepted and

valid" methods in determining whether overpayments have been

made, and the Petitioner "may introduce the results of such

statistical methods and its other audit findings as evidence of

overpayment."

8. The Petitioner used a single - s tage cluster sample

technique to select a sample of Medicaid recipients for review

from the Respondent's total billings during the audit period.

Cluster sampling is a common and well - accepted sampling

methodology, and the evidence is sufficient to establi sh that it

produce d a valid group of Medicaid recipients for review.

9. After the claims review was complete , the Petitioner

then applied an extrapolation technique to calculate the alleged

overpayment. The Petitioner presented sufficient evidence to

e stablish that the extrapolation technique produced a valid

calculation of the overpayment at issue in this case.

1 0 . By a certified letter dated July 27, 2010, the

Petitioner notified the Respondent that an audit was being

conducted for the period from J uly 1, 2007 , through June 30, 2009

(the "audit period"), and requested relevant documentation

related to the Medicaid program recipients identified therein.

The documents requested specifically included "eeg reports and

hospital records for inpatient serv ices." The letter stated that

the failure to provide all Medicaid - related records would result

in sanctions.

1 1 . By transmittal letter dated September 2, 2010, the

Respondent forwarded to the Petitioner "nearly complete" copies

of records related to the audit.

1 2 . By a certified letter to the Respondent dated

January 4, 2011, the Petitioner issued a preliminary audit report

alleging that the Respondent received an overpayment of

$115,393.14 during the audit period.

1 3 . By transmittal letter dated Feb ruary 4, 2011, previous

legal counsel for the Respondent forwarded to the Petitioner "the

entire medical files and documentation" for the recipients

identified as part of the audit sample.

1 4 . On June 1, 2011, the Petitioner issued the FAR,

alleging that the Respondent had received an overpayment of

$110,712.09 during the audit period. The FAR also advised that a

fine of $24,642.42 and audit costs of $7,336.12 were being

assessed, which brought the total amount due from the Respondent

to $142,690.63.

1 5 . As previously stated, the parties resolved a

significant portion of the disputed charges at the commencement

of the hearing. The remaining disputed charges are for a variety

of extended electroencephalogram (EEG) services. Extended EEG

monitoring is c ommonly referred to as "long - term monitoring "

(LTM). A standard EEG takes about 30 minutes to complete,

including the testing period, while an LTM occurs over a 24 - hour

period, or longer. LTMs are billed in units of 24 - hour periods.

1 6 . The coding of c laims for Medicaid reimbursement

purposes is set forth in the "Current Procedural Terminology"

(CPT) codebook. The CPT codes relevant to this dispute are as

follows:

CPT Code 95951: Monitoring for localization

of cerebral seizure focus by cable or radi o,

16 or more channel telemetry, combined

electroencephalogram (eeg) and video

recording and interpretation (e.g., for

presurgical localization), each 24 hours.

CPT Code 95956: Monitoring for localization

of cerebral seizure focus by cable or radio,

16 or more channel telemetry,

electroencephalogram (eeg) recording and

interpretation (each 24 hours).

CPT Code 95813 : Electroencephalogram (eeg);

extended monitoring, greater than one hour.

17 . Applicable Medicaid regulations require that "medical

nec essity" be documented by specific records made at the time the

services were provided , and that the records fully identify the

medical basis and the need for the services. In other words, a

provider must document the rationale for conducting an LTM at the

time of making the decision to perform the extended study.

18 . The Petitioner has asserted that the Respondent failed

to submit sufficient documentation to establish that the disputed

charges identified herein were for "medically necessary"

services. A s to this specific issue, the Petitioner presented

the testimony of Dr. Abram, and the Respondent testified on his

own behalf and presented the deposition testimony of

Dr. Foradada. The following recipient - specific Findings of Fact

are based on the testim ony of Dr. Abram, which was persuasive and

has been credited.

Recipient #3

19 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #3 on

11/02/07. The charge of $144.15 was paid by Medicaid a nd is not

disputed .

2 0 . The Respondent also billed Medicaid for CPT Code 95951

("Eeg Monitoring/Videorecord") services provided to Recipient #3

on 11/02/07 and for the two following dates of 11/03/07 and

11/04/07. The Respondent billed Medicaid $463.44 for each date,

for a total of $1,390.32. The Petitioner has asserted that these

charges are overpayments.

2 1 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the do cumentation maintained at the time

the disputed services were rendered to Recipient #3 fail to

document the medical necessity for the services. Accordingly,

the charges totaling $1,390.32 were improperly billed to

Medicaid.

Recipient #6

2 2 . The Responde nt billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #6 on

11/28/0 8 . The charge of $186.61 was paid by Medicaid and is not

disputed .

2 3 . The Respondent also billed Medicaid for CPT Code 95956

("Eeg Monito ring, Cable/Radio") services provided to Recipient #6

on 11/28/08 and 11/29/08, each in an amount of $505.63, for a

total of $1,011.26. The Petitioner has asserted that these

charges are overpayments.

2 4 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation maintained at the time

the disputed services were rendered to Recipient #6 fail to

document the medical necessity for the services. Accordingly,

the charges totaling $1,011.26 were improperly billed to

Medicaid.

Recipient #17

2 5 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #17 on

07/06/07. The charge of $185.89 was paid by Medica id and is not

disputed .

2 6 . The Respondent also billed Medicaid for CPT Code 95956

("Eeg Monitoring, Cable/Radio") services provided to

Recipient #17 on 07/06/07 and on the two following dates of

07/07/07 and 07/08/07. The Respondent charged Medicaid $4 88.29

for each date, for a total of $1,464.87. The Petitioner has

asserted that these charges are overpayments.

27 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation maintained at the time

the disputed services were rendered to Recipient #17 fail to

document the medical necessity for the services. Accordingly,

the charges totaling $1,464.87 were improperly billed to

Medicaid.

Recipient #20

28 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #20 on

04/29/08. The charge of $186.61 was determined by the Petitioner

to be an overpayment , and the Respondent has not challenged the

determina tion.

29 . The Respondent also billed Medicaid for CPT Code 95951

("Eeg Monitoring/Videorecord") services provided to Recipient #20

on 04/29/08 and on the two following dates of 04/30/08 and

05/01/08. The Respondent charged Medicaid $597.65 for each date .

The Petitioner has asserted that the records do not document the

medical necessity for the second and third dates of service and ,

therefore , has determined the total disputed charge of $1,195.30

to be an overpayment.

3 0 . Although at the hearing the Re spondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation maintained at the time

the disputed services were rendered to Recipient #20 fail to

document the medical necessity for the second a nd third dates of

service. Accordingly, the charges totaling $1,195.30 were

improperly billed to Medicaid.

Recipient #22

3 1 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #22 on

02/01/0 8. The charge of $186.60 was determined by the Petitioner

to be an overpayment , and the Respondent has not challenged the

determination.

3 2 . The Respondent also billed Medicaid for CPT Code 95951

(" Eeg Monitoring/Videorecord") services provided to Recip ient #22

on 02/01/08 and on the two following dates of 02/02/08 and

02/03/08. The Respondent charged Medicaid $597.64 for each date.

The Petitioner has asserted that the records do not document the

medical necessity for the second and third dates of serv ice and ,

therefore , determined the total disputed charge of $1,195.28 to

be an overpayment.

3 3 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation mai ntained at the time

the disputed services were rendered to Recipient #22 fail to

document the medical necessity for the second and third dates of

service. Accordingly, the charges totaling $1,195.28 were

improperly billed to Medicaid.

Recipient #24

34. The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #24 on

10/05/07. The charge of $144.15 was determined by the Petitioner

to be an overpayment , and the Respondent has not challenged the

deter mination.

3 5 . The Respondent also billed Medicaid for CPT Code 95951

(" Eeg Monitoring/Videorecord") services provided to Recipient #2 4

on 10/05/07 and on the two following dates of 10/06/07 and

10/0 7 /07. The Respondent charged Medicaid $463.44 for each date.

The Petitioner has asserted that the records do not document the

medical necessity for the second and third dates of service and ,

therefore , determined the total disputed charge of $926.88 to be

an overpayment.

3 6 . Although at the hearing the Resp ondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation maintained at the time

the disputed services were rendered to Recipient #24 fail to

document the medical necessity for the second and third dates of

service. Accordingly, the charges totaling $926.88 were

improperly billed to Medicaid.

Recipient #25

September 2007

37 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake And Asleep") provided to Recipient #25 on

09/26/07. The charge of $144.15 was determined by the Petitioner

to be an overpayment , and the Respondent has not challenged the

determination.

38 . The Respondent also billed Medicaid for CPT Code 95951

(" Eeg Monitoring/Videorecord") services provid ed to Recipient #25

on 09/26/07 and on the two following dates of 09/27/07 and

09/28/07. The Respondent charged Medicaid $463.44 for each date.

The Petitioner has asserted that the records do not document the

medical necessit y for the third date of servi ce and , therefore ,

determined the total disputed charge of $463.44 to be an

overpayment.

March 2009

39 . The Respondent billed Medicaid for a standard EEG (CPT

Code 95819, "Eeg, Awake a nd Asleep") provided to Recipient #25 on

03/24/09. The charge of $139 .77 was determined by the Petitioner

to be an overpayment , and the Respondent has not challenged the

determination.

4 0 . The Respondent also billed Medicaid for CPT Code 95951

(" Eeg Monitoring/Videorecord") services provided to Recipient #25

on 03/24/09 a nd on the two following dates of 03/25/09 and

03/26/09. The Respondent charged Medicaid $463.44 for each date.

The Petitioner has asserted that the records do not document the

medical necessity for the second and third date s of service and ,

therefore , de termined the total disputed charge of $926.88 to be

an overpayment.

4 1 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the services, the documentation maintained at the time

the disputed services were rendered to Recipient #2 5 fail to

document the medical necessity for the dates of service that were

determined as overpayments by the Respondent. Accordingly, the

charges of $463.44 and $926.88 were improperly billed to

Medicaid.

Recipient #27

4 2 . For services rendered to Recipient #27 on 09/25/08, the

Respondent billed Medicaid $186.61 for a standard EEG (CPT Code

95819, "Eeg, Awake And Asleep"), $213.94 for CPT Code 95813

("Eeg, Over 1 Hour") and $597.65 for CPT Code 95951 (" Eeg

Monitoring/Videorecord").

4 3 . CPT Code 95951 provides for a 24 - hour monitoring period

and the charge of $597.65 for 09/25/08 was paid by Medicaid.

Because Medicaid paid the $597.65 charge for CPT Code 95951, the

Petitioner has determined that the charge of $213.94 on the same

date for CPT Code 95813 ("Eeg, Over 1 Hour") was an overpayment.

The Respondent has challenged the determination, but no credible

evidence was offered to demonstrate any medical necessity for

both services to have been performed on 09/25/08.

4 4 . The charge of $186.61 on 09/25/08 for CPT Code 95819

( " Eeg, Awake And Asleep") was determined by the Petitioner to be

an overpayment , and the Respondent has not challenged the

determination.

4 5 . The Respondent billed Medicaid for CPT Cod e 95951 (" Eeg

Monitoring/Videorecord") services for each of the next two

service dates, 09/26/08 and 09/27/08.

4 6 . The Respondent charged Medicaid $597.65 for each date.

The Petitioner has asserted that the records do not document the

medical necessity for the charges on these dates and , therefore ,

determined the total disputed charge of $1,195.30 to be an

overpayment.

47 . Although at the hearing the Respondent testified as to

the medical condition of the patient and his rationale for

ordering the serv ices, the documentation maintained at the time

the disputed services were rendered to Recipient #27 fail to

document the medical necessity for the dates of service that were

determined as overpayments by the Petitioner. Accordingly, the

charges of $213.94 and $1,195.30 were improperly billed to

Medicaid.

CONCLUSIONS OF LAW

48 . The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of this

proceeding. §§ 120.569 and 120.57, Fla . Stat. (2013).

49 . The burden of proof is on the Petitioner to prove the

material allegations by a preponderance of the evidence.

Southpointe Pharmacy v. Dep't of HRS , 596 So. 2d 106, 109 (Fla.

1st DCA 1992).

5 0 . The Petitioner is authorized by section 409.913 to

monitor the activit ies of Medicaid providers and to recover

"overpayments" of Medicaid claims. Overpayments are defined as

"any amount that is not authorized to be paid by the Medicaid

program whether paid as a result of inaccurate or improper cost

reporting, improper claim ing, unacceptable practices, fraud,

abuse, or mistake." In relevant part, "abuse" is defined as

"reimbursement for goods or services that are not medically

necessary or that fail to meet professionally recognized

standards for health care."

5 1 . The dete rmination of medical necessity is based on the

records that exist at the time the service is provided. The

Respondent is charged with the responsibility for assuring not

only that claims for payment are for services that are medically

necessary , but also that the medical necessity is "fully and

properly" documented. Section 409.913(7) provides, in relevant

part, as follows:

When presenting a claim for payment under the

Medicaid program, a provider has an

affirmative duty to supervise the provision

of, and be responsible for, goods and

services claimed to have been provided, to

supervise and be responsible for preparation

and submission of the claim, and to present a

claim that is true and accurate and that is

for goods and services that:

* * *

(b) A re Medicaid - covered goods or services

that are medically necessary.

* * *

(f) Are documented by records made at the

time the goods or services were provided,

demonstrating the medical necessity for the

goods or services rendered. Medicaid goods

or services are excessive or not medically

necessary unless both the medical basis and

the specific need for them are fully and

properly documented in the recipient's

medical record.

5 2 . The audit report, if accompanied by supporting work

papers, is "evidenc e of the overpayment." § 409.913(22) , Fla.

Stat . Absent credible evidence to the contrary, the audit report

and work papers establish the total overpayment. In this case,

the Petitioner met the burden of establishing that the disputed

charges referenced herein were not properly billed to Medicaid

and are overpayments that may be recovered by the Petitioner.

5 3 . As previously noted, the Petitioner announced at the

commencement of the hearing that the proposed fine had been

reduced to $3,500. The revision was based on a fine of $500 for

alleged violations of the version of Florida Administrative Code

Rule s 59G - 9.070(7)(c) and (e) in effect during the audit period.

In order to impose a fine in this case, the Petitioner must

establish the violations by clea r and convincing evidence. Dep't

of Banking & Fin. v. Osborne Stern & Co . , 670 So. 2d 932, 935

(Fla. 1996). The evidence is insufficient to warrant imposition

of a fine in this case.

5 4 . Section 409.91 3 (17) provides as follows:

(17) In determining the appropriate

administrative sanction to be applied, or the

duration of any suspension or termination,

the agency shall consider:

(a) The seriousness and extent of the

violation or violations.

(b) Any prior history of violations by the

provider relat ing to the delivery of health

care programs which resulted in either a

criminal conviction or in administrative

sanction or penalty.

(c) Evidence of continued violation within

the provider's management control of Medicaid

statutes, rules, regulations, or policies

after written notification to the provider of

improper practice or instance of violation.

(d) The effect, if any, on the quality of

medical care provided to Medicaid recipients

as a result of the acts of the provider.

(e) Any action by a licensing agency

respecting the provider in any state in which

the provider operates or has operated.

(f) The apparent impact on access by

recipients to Medicaid services if the

provider is suspended or terminated, in the

best judgment of the agency.

5 5 . The issue in the case presented for hearing was whether

the records that existed at the time of disputed services were

sufficient to establish that the services were medically

necessary. Dr. Abram persuasively opined that the records

provided to the Petitioner during the audit period were

insufficient to establish that the disputed services were

medically necessary. However, the evidence presented by the

Respondent was sufficient to establish that there was at least a

reasonable argument to the cont rary. Nothing in section

409.91 3 (17) suggests that the imposition of a fine in this case

would be appropriate.

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 finding a Medicaid overpayment

of $9,983.47 as set forth herein, to be added to the overpayment

amount associated with the stipulated disposition of disputed

charges resolved during the hearing by the parties.

Pursuant to s ection 409. 913(23) , the Petitioner is entitled

to recover all investigative, legal and expert witness costs.

Jurisdiction is retained to determine the amount of appropriate

costs , if the parties are unable to agree. Within 30 days after

entry of the final order, ei ther party may file a request for a

hearing on the amount. Failure to request a hearing within

30 days after entry of the final order shall be deemed to indicate

that the issue of costs has been resolved.

DONE AND ENTERED this 24th day of April , 2014 , 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

(850) 488 - 9675

Fax Fili ng (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 24th day of April , 2014 .

ENDNOTE

1/ Unless otherwise noted, a ll statutory references are to

Florida Statutes (20 1 0 ).

COPIES FURNISHED:

Eliza beth Dudek, Secretary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308 - 5407

Stuart Williams, General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 - 540 7

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 - 5407

Frank P. Rainer, Esquire

Broad and Cassel

Suite 400

215 South Monroe Street

Tallahassee, Florida 32301 - 1804

Karen A. Brodeen, Esquire

Robert A. Milne, Esquire

Office of the Attorney General

The Capitol , Plaza Level 01

Tallahassee, Florida 32399 - 1050

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.