14-002055 Sunbelt Health And Rehab Center, Inc. vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Wednesday, May 7, 2014.

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STATE OF FLORIDA A G1rlZ" Y

AGENCY FOR HEALTH CARE ADMINISTRATION

2014GCT- I All: 42

SUNBELT HEALTH AND REHAB

CENTER, INC.,

Petitioner,

VS. Provider No.: 032041200

Invoice No.: NH16766

RENDITION NO.: AHCA- 14 - 690 S- MDA

STATE OF FLORIDA, AGENCY FOR HEALTH

CARE ADMINISTRATION,

Respondent.

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Settlement Agreement.

The parties are directed to comply with the terms of the attached settlement agreement,

attached hereto and incorporated herein as Exhibit " 1." Based on the foregoing, this file is

CLOSED.

P~ f/~ 1 1'! P1

DONE and ORDERED on this the 204day of 2014, in Tallahassee,

Florida.

ELI / BETH, % DEK, SECRETARY

Agency for Health Care Administration

Final Order

Invoice No. NH16766

Page 1 of 3

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.

Peter A. Lewis, Esquire Agency for Health Care Administration

Peter A Lewis, P. L. Bureau of Finance and Accounting

3023 North Shannon Lakes Drive Interoffice Mail)

Suite 101

Tallahassee, Florida 32309

palewis@petelewislaw. com

Via Electronic Mail)

Bureau of Health Quality Assurance Jeffries Duvall, Esquire

Agency for Health Care Assistant General Counsel

Administration Agency for Health Care Administration

Interoffice Mail) Interoffice Mail)

Stuart Williams, General Counsel Zainab Day, Medicaid Audit Services

Agency for Health Care Agency for Health Care Administration

Administration Interoffice Mail)

Interoffice Mail)

Shena Grantham, Chief State of Florida, Division of

Medicaid FFS Counsel Administrative Hearings

Interoffice Mail) The Desoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399- 3060

Via U. S. Mail)

Final Order

Invoice No. NH16766

Page 2 of 3

CERTIFICATE OF SERVICE

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

to the above named addressees by the designated method of delivery on this the !~ shday

of ( 07~ A~. ca/ 2014.

Richard J. Shoop, Esquire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, Building # 3

Tallahassee, Florida 32308- 5403

850) 412- 3671

Final Order

Invoice No. NH16766

Page 3 of 3

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SUNBELT HEALTH AND

REHAB CENTER, INC.,

Petitioner,

PROVIDER NO.: 032041200

Vs. INVOICE NO.: NH16766

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Respondent

SETTLEMENT AGREEMENT

The Respondent, Agency for Health Care Administration (" AHCA" or " Agency"), and

the Petitioner, Sunbelt Health and Rehab Center, Inc., (" PROVIDER"), stipulate and agree as

follows:

1. This Agreement is entered into between the parties to resolve disputed

issues arising from a collection matter assigned case number NH16766.

2. The PROVIDER is a Medicaid provider, Provider Number 032041200, in the

State of Florida operating a nursing home facility.

3. On July 15, 2013, the Agency notified the PROVIDER of its determination that

PROVIDER was responsible to the Agency for an overpayment in the amount of $ 95, 99. 610.

4. The PROVIDER timely filed an appeal regarding this determination

challenging the Agency' s application of the interest rate in the FRVS property component

that had been used to set the Medicaid per diem rate generating the overpayment.

5. Subsequent to the filing of the petition for administrative hearing, AHCA and

the PROVIDER exchanged documents and discussed the adjustment to the interest rate

used to determine the FRVS component of the Medicaid per diem. As a result of the

aforementioned exchanges, the parties agree that AHCA will revise the PROVIDER' s

January 1, 2014 per diem rates to reflect a fixed FRVS interest rate of 5. 65%. The 5. 65%

fixed interest rate shall be used to establish the FRVS component of PROVIDER' s Medicaid

per diem rate for all subsequent rate semesters unless the interest rate is required to be

Sunbelt Health & Rehab Center, Inc.

Settlement Agreement

Page 1 of 5

revised in accordance with the provisions of the Florida, Title XIX, Long- Term Care

Reimbursement Plan.

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

the PROVIDER and AHCA expressly agree to the adjustment resolutions, as set forth in

paragraph 5 above, completely resolve and settle this case and this agreement constitutes

the PROVIDER' S withdrawal of its petition for administrative hearing, with prejudice.

7. The PROVIDER and AHCA further agree that the Agency shall recalculate the

per diem rates for the above- stated period and issue a notice of the recalculation. Where

the PROVIDER was overpaid, the PROVIDER will reimburse the Agency the full amount of

the overpayment within thirty ( 30) days of such notice. Where the PROVIDER was

underpaid, AHCA will pay the PROVIDER the full amount of the underpayment within forty-

five ( 45) days of such notice.

Payment shall be made to:

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid Accounts Receivable- Mail Stop 14

2727 Mahan Drive, Building 2, Suite 200

Tallahassee, Florida 32308

Notices to the PROVIDER shall be made to:

Peter A. Lewis, Esquire

Peter A. Lewis, P. L.

3023 North Shannon Lakes Drive, Suite 101

Tallahassee, Florida 32309

Payment shall clearly indicate it is pursuant to a settlement agreement and shall

reference the case number and the Medicaid provider number.

8. PROVIDER agrees that failure to pay any monies due and owing under the

terms of this Agreement shall constitute the 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 the PROVIDER for any Medicaid claims.

9. Either party is entitled to enforce this Agreement under the laws of the State

of Florida; the Rules of the Medicaid Program; and all other applicable federal and state

Sunbelt Health & Rehab Center, Inc.

Settlement Agreement

Page 2 of 5

laws, rules, and regulations.

10. This settlement does not constitute an admission of wrongdoing or error by

the parties with respect to this case or any other matter.

11. Each party shall bear their respective attorney' s fees and costs, if any.

12. The signatories to this Agreement, acting in their respective representative

capacities, are duly authorized to enter into this Agreement on behalf of the party

represented.

13. The parties further agree that a facsimile or photocopy reproduction of this

Agreement shall be sufficient for the parties to enforce the Agreement. The PROVIDER

agrees, however, to forward a copy of this Agreement to AHCA with original signatures,

and understands that a Final Order may not be issued until said original Agreement is

received by AHCA.

14. 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.

15. This Agreement constitutes the entire agreement between the PROVIDER and

AHCA, including anyone acting for, associated with, or employed by them, respectively,

concerning all matters and supersedes any prior discussions, agreements, or

understandings: There are no promises, representations, or agreements between the

PROVIDER and AHCA other than as set forth herein. No modifications or waiver of any

provision shall be valid unless a written amendment to the Agreement is completed and

properly executed by the parties.

16. This is an Agreement of settlement and compromise, recognizing 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.

17. The PROVIDER expressly waives in this matter their right to any hearing

pursuant to §§ 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

Sunbelt Health & Rehab Center, Inc.

Settlement Agreement

Page 3 of 5

entitled by law or rules of the Agency regarding these proceedings and any and all issues

raised herein, other than enforcement of this Agreement. The PROVIDER further agrees the

Agency shall issue a Final Order which adopts this Agreement.

18. 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.

19. To the extent 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.

20. This Agreement shall inure to the benefit of and be binding on each party' s

successors, assigns, heirs, administrators, representatives, and trustees.

SUNBELT HEALTH AND

REHAB CENTER, INC.

Dated: 2014

Providers' Representative

eo Dated: 2014

Printed Title of Pro ders'

Repres e

Dated: 2014

Legal Counsel for Provider

Sunbelt Health & Rehab Center, Inc.

Settlement Agreement

Page 4 of S

FLORIDA AGENCY FOR HEALTH CARE

ADMINISTRATION

2727 Mahan Drive, Mail Stop # 3

Tallahassee, Florida 32308- 5403

n Dated: Q 2014

Jus Senio

4; Stuart 9= Dated: 1 2014

Williams

General Counsel

Sh a Dated: l 2014

Granth

Medicaid FFS Chief Counsel

i4 ? Dated: 42014

ffrie vall

ss" General Counsel

i

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Sunbelt Health & Rehab center, Inc.

Settlement Agreement

Page 5 of 5

t

RICK SCOTT FI0RID4AGFNCYF0RH: AIIHCARFA MINISIfL=. N fi)

GOVERNOR Better Health Care for all Floridians ELIZABETH SECRETARY DUDEK

CERTIFIED MAIL RECEIPT REQUESTED:

91 7108 2133 3937" 630" 18 0l~

July 15, 2013

Nursing Home Administrator

Sunbelt Health & Rel ab Center

305 East Oak Street

4popka, FL 32703

Dear Administrator:

You have been notified by the Office of Medicaid Cost Reimbursement Analysis of adjustments

to your Medicaid reimbursement rates on the remittance voucher run dated: 7/ 1313.

The adjustments resulted from changes in your cost reports. This action has resulted in a balance

due to the Agency in the amount of 99 S95, 610. for provider number 032041200/ invoice number

NH16766.

If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency

shall withhold Medicaid payments in accordance with the provisions of Chapter 409. 27), 913(

F. S. Furthermore, pursuant to Sections 409. 25) 913( and 15), 409. 913( F. S., 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. Likewise, failure to comply with all sanctions

applied or due dates may result in additional sanctions being imposed. If the overpayment

cannot be recouped by this office, Florida law authorizes referral of your account to the

Department of Health and to a collection agency. All costs incurred by the Agency resulting

from collection efforts will be added to your balance. Additionally, be advised that this referral

does not relieve you of your obligation to make payment in full or contact this office to arrange

mutually agreeable repayment terms.

In addition, amounts due to the Agency shall bear interest at ten percent ( 10%) per annum from

the date of this letter on the unpaid balance until the account is paid in full. The interest accrual

will not be assessed if payment is received by the Agency within 30 days.

You have the right to request a formal or informal hearing pursuant to Section 120. 569, F. S. If a

request for a formal hearing is made, the petition must be made in compliance with Section 28-

106. 201, F. C. A. and mediation may be available. If a request for an informal hearing is made,

the petition must be made in compliance with rule Section 28- 301, 106. C. F. A. Additionally, you

are hereby informed that if a request for a hearing is made, the petition must be received by the

Agency within twenty- one ( 21) days of receipt of this letter. For more information regarding

your hearing and mediation rights, please see the attached Notice of Administrative

Hearing and Mediation Rights.

2727 Mahan Drive, MS# 14 f; Visit AHCA online at

Tallahassee, Florida 32308 http:// myflorida. ahca. com

an ,,. E sod`

Please include a copy of the enclosed remittance advice to assure

payments to your provider account. proper posting of

Should you have any questions regarding the Medicaid provider account balance

contained in this contact information

notice, please Julie Chasar ( 850) 412- 4877. Questions regarding the

reimbursement rate changes should be directed to Thomas Parker, Office of Medicaid

Reimbursement, at ( 850) 412- 4110. Cost

Sincerely,

Julie Chasar

Medicaid Accounts Receivable

JPC

July 15, 2013

PLEASE INCLUDE THIS REMITTANCE ADVICE WITH YOUR PAYMENT

Remit Payment to:

Agency for Health Care Administration

Medicaid Accounts Receivable MS# 14

2727 Mahan Drive Bldg. 2 Ste. 200

Tallahassee, FL 32308

Attn: Sharon Dixon

FROM:

Sunbelt Health S Rehab Center

30, East Oak- Streel.

Apopka, F€.. 32703

Provider No. 032041200

Invoice No. NH 16766

STATEMENT OF ACCOUNT

CERTIFIED MAIL: 91 7108 2133 3937 6307 1800

VOUCHER RUN DATE: 7! 1 13! 3

BALANCE DUE: 05. 99 610.

PAYMENT IS DUE WITHIN 30 DAYS FROM THE DATE OF

THIS LETTER.

Amount Enclosed: $

NOTICE OF ADMINISTRATIVE HEARING AND

MEDIATION RIGHTS

You have the right to request an administrative

120. 57, Florida Statutes. If you disagree with the facts hearing pursuant to Sections 120. 569 and

Balance Report ( hereinafter stated in the foregoing Suspended

Section SBR), you may request a formal administrative hearing to

120. 1), 57( Florida Statutes. If you do not dispute the facts stated in pursuant

there are additional reasons to grant the relief the SBR, but believe

administrative hearing to you seek, you may request an informal

Section pursuant Section 120. 2), 57( Florida Statutes.

120. 573, Florida Statutes, mediation may be available if have Additionally, pursuant to

administrative hearing, as discussed more below. you chosen a formal

The written for an fully

either Rule request administrative hearing must conform to the

28- 201( 106. 2) or Rule 28- 301( 106. 2), Florida requirements of

received by the Agency for Health Care Administrative Code, and must be

you received the SBR. The address for Administration, by 5: 00 P. M. no later than 21 days after

filing the written request for an administrative hearing is:

Richard J. Shoop, Esquire

Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop # 3

Tallahassee, Florida 32308

Fax: ( 850) 921- 0158

The request must be legible, on 8 % 11- inch

by white paper, and contain:

1. Your name, address, telephone

known, and name, number, any Agency identifying number on the SBR, if

2. An address, and telephone number of your if

explanation of how your substantial interests will be representative, any;

in the SBR; affected by the action described

3. A statement of when and how

4. For a for you received the SBR;

5. request formal hearing, a statement of all issues

For a request for formal hearing, a concise disputed of material fact;

as the rules and statutes which statement of the ultimate facts alleged, as well

6. For a entitle you to relief;

7. request for formal hearing, whether you request if it

For a request for informal hearing, what bases mediation, is available;

to the Agency; and support an adjustment to the amount owed

8. A demand for relief.

A formal hearing will be held if there are

mediation may be available in disputed issues of material fact. Additionally,

neutral third to assist conjunction with a formal hearing. Mediation is a to

settlement of party the parties in a legal or administrative way use a

give the their case. If you and the Agency agree to it proceeding to reach a

up right to a hearing. Rather, you and the mediation, does not mean that you

mediation. Agency will try to settle your case first with

If you request mediation, and the

Agency to set up a time for the Agency agrees to it, you will be contacted by the

mediation agreement is mediation and to enter into a mediation

matter will not reached within 10 days the agreement. If a

proceed without mediation. The mediation following request for mediation, the

having entered into the must be concluded within 60 of

The mediation agreement, unless you and the Agency agree to a different days

agreement between you and the will time period.

mediator, the allocation of costs and fees Agency include provisions for selecting the

of discussions and documents associated with the mediation, and the

be shared involved in the mediation. Mediators charge confidentiality fees

equally by you and the Agency. hourly that must

If a written request for an administrative

your right to have the intended hearing is not timely received you will have waived

the action action reviewed pursuant to Chapter 120, Florida

set forth in the SBR shall be conclusive and final. Statutes, and