14-000997 Agency For Health Care Administration vs. Senior Care Group, Inc., D/B/A The Inn At Lakeshore Villas Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, March 12, 2014.

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AHCA AHCA

STATE STATE OF OF FLORIDA FLORIDA AGENCY AGENCY CLERK CLERK

AGENCY AGENCY FOR FOR HEALTH HEALTH CARE CARE ADMINISTRATION ADMINISTRATION

2014 2014 MAR MAR 31 31 A A II: II: 23 23

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

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Petitioner, Petitioner,

vs. vs. DOAH DOAH No. No. 14-997 14-997

AHCA AHCA No. No. 2013008675 2013008675

SENIOR SENIOR CARE CARE GROUP, GROUP, INC. INC. d/b/a d/b/a RENDITION RENDITION NO.: NO.: AIICA- AIICA- I I Y. Y. - - oab oab Cf Cf -S-OLC -S-OLC

THE THE INN INN AT AT LAKESHORE LAKESHORE VILLAS, VILLAS,

Respondent. Respondent.

-------------------'/ -------------------'/

FINAL FINAL ORDER ORDER

Having Having reviewed reviewed the the Administrative Administrative Complaint, Complaint, and and all all other other matters matters of of record, record, the the Agency Agency for for

Health Health Care Care Administration Administration finds finds and and concludes concludes as as follows: follows:

I. I. The The Agency Agency has has jurisdiction jurisdiction over over the the above-named above-named Respondent Respondent pursuant pursuant to to Chapter Chapter 408, 408,

Part Part II, II, Florida Florida Statutes, Statutes, and and the the applicable applicable authorizing authorizing statutes statutes and and administrative administrative code code provisions. provisions.

2. 2. The The Agency Agency issued issued the the attached attached Administrative Administrative Complaint Complaint and and Election Election of of Rights Rights form form to to

the the Respondent. Respondent. (Ex. (Ex. I) I) The The Election Election of of Rights Rights form form advised advised of of the the right right to to an an administrative administrative hearing. hearing.

3. 3. The The parties parties have have since since entered entered into into the the attached attached Settlement Settlement Agreement. Agreement. (Ex. (Ex. 2) 2)

Based Based upon upon the the foregoing, foregoing, it it is is ORDERED: ORDERED:

I. I. The The Settlement Settlement Agreement Agreement is is adopted adopted and and incorporated incorporated by by reference reference into into this this Final Final Order. Order.

The The parties parties shall shall comply comply with with the the terms terms of of the the Settlement Settlement Agreement. Agreement.

2. 2. The The Administrative Administrative Complaint Complaint is is DISMISSED. DISMISSED.

ORDERED ORDERED at at Tallahassee, Tallahassee, Florida, Florida, on on this this 2L 2L day day :, :, 2014. 2014.

ec ec etary etary

e e Administration Administration

I I

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 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 appellatedistrict

where the Agency maintains its headquarters orwhere a party resides. Review of 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.

CERTIFICATE OF SERVICE

I CERTIFY that a true and correct this Final Order was served on the below-named

persons by the method designated on this ,2014.

Richard So, gency Cler

Agency for Health Care Administration

2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: [phone]

Jan Mills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

(Electronic Mail) (Electronic Mail)

Thomas J. Walsh II Anna G. Small, Esq.

Office of the General Counsel Allen Dell, P.A.

Agency for Health Care Administration 202 South Rome A venue

(Electronic Mail) Tampa, Florida 33606

(U.S. Mail)

Linzie F. Bogan

Administrative Law Judge

Division of Administrative Hearings

(Electronic Mail)

cc: State Survey Agency

State Medicaid Agency

Medicare Administrative Contractors

Jackie Glaze, DMCHO, ARA

Stephanie M. Davis, LTCCEB Manager

NOTE TO THE MEDICARE ADMINISTRATIVE CONTRACTORS:

This letter replaces the CMS-2007, Provider Tie-In Notice