16-000347MPI Agency For Health Care Administration vs. Lazaro Miguel Garcia, M.D. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, February 9, 2016.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

! . • J .•

STATE OF FLORIDA, AGENCY :'. -·: ·'i;. c'Lc:::\\

FOR HEALTH CARE ADMINISTRATION,

2016 MAR I b 2: 25

Petitioner,

vs. C.I.: No. 14-1332-000

Provider No. 376490700

LAZARO MIGUEL GARCIA, NPI No. 1811203946

License No. ME67163

Respondent.

_____________________________ !

FINAL ORDER

THIS CAUSE concerns a Medicaid audit conducted by the Agency for Health Care

Administration ("Agency"). The subject ofthe audit was Lazaro Miguel Garcia ("Respondent").

The Agency served its Final Audit Report ("FAR"), dated September 4, 2014, on the

Respondent. The FAR contained findings that Respondent had been overpaid in the amount of

$123,839.80. The Agency, in the FAR, assessed sanctions in the amount of $49,535.92 and costs

in the amount of$1,972.16. A copy ofthe FAR is annexed hereto as Exhibit 1.

On October 17, 2014, the Respondent filed a Petition for Formal Administrative Hearing.

A copy of the Petition for Formal Hearing is annexed hereto as Exhibit 2.

Thereafter, the Respondent provided additional information in the form of medical records

and billing information which reduced the overpayment amount to $110,988.80. Based on the new

information and submissions, the Agency reduced the sanctions to $44,395.52. The costs

associated with the audit increased to $2,364.43. The total amount due and outstanding is presently

one hundred fifty seven thousand seven hundred forty eight dollars and seventy five cents

($157,748.75).

On February 9, 2016, the parties filed a Stipulation withdrawing the Respondent's Petition

for Formal Hearing and agreeing to the amount of$157,748.75 as the total amount due and owing

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(inclusive of the overpayment, costs and sanctions). A copy of the Stipulation of Withdrawal is

annexed hereto as Exhibit 3.

Based on the foregoing,

IT IS THEREFORE ORDERED AND ADJUDGED THAT:

Respondent's request for a formal administrative hearing is deemed withdrawn and the

Agency's September 4, 2014 Final Audit Report shall be upheld as final with the exception ofthe

amounts due as agreed upon in the Stipulation of Withdrawal. Respondent shall govern himself

accordingly.

Unless payment has already been made, payment in the amount of$157,748.75 is now due

from Respondent as a result of the agency action. Such payment shall be made in full within 30

days of the rendition of this Final Order unless other payment arrangements have been made. The

payment shall be made by check payable to Agency for Health Care Administration, and shall be

mailed to the Agency for Health Care Administration, Attn. Medicaid Accounts Receivable, Office

of Finance and Accounting, 2727 Mahan Drive, Mail Stop 14, Tallahassee, FL 32308.

DONE and ORDERED on this of ¥....< ,="" 20jtf,="" in="">

Florida.

rZPi.f!4:

v ELIZA;TH SECRETARY

Agency for Health Care Administration

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 BYLAW, WITH THE

DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE

AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES.

REVIEW 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:

Javier Banos, Esquire James Ross, Esquire

Counsel for Respondent (Interoffice Mail)

3126 Coral Way

Miami, Florida 3 314 5

Telephone: [phone]

jbanos@lawservices. us

(E-Mail)

Dr. Lazaro Miguel Garcia Finance & Accounting

3626 NW 7th Street (Interoffice Mail)

Miami, Florida 33125

Shena Grantham Stuart F. Williams

Medicaid Administrative Lit. Chief Counsel General Counsel

(Interoffice Mail) (Interoffice Mail)

Robi Olmstead Health Quality Assurance

Administrator (E-Mail)

MPI

(Interoffice Mail)

Kelly Bennett, Chief, MPI

(Interoffice Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy ofthe foregoing has been furnished to

the above named addressees by U.S. Mail or other designated method on this

Richar J. Shoop, Esquire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

[phone]/FAX [phone]

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

CERTIFIED MAIL No.: 7010 1060 0001 6939 4601

September 4, 2014

Provider No: 376490700

NPI No: 1811203946

License No.: ME67163

Lazaro Miguel Garcia

3626 NW 7th Street

Miami, FL 33125

In Reply Refer to

FINAL AUDIT REPORT

C.l.: No. 14-1332-000

Dear Provider:

The Agency for Health Care Administration (Agency), Office of the Inspector General/Medicaid

Program Integrity, has completed a review of claims for Medicaid reimbursement for dates of

service during the period January 1, 2010, through December 31, 2012. A preliminary audit

report dated July 31, 2014 was sent to you indicating that we had determined you were overpaid

$123,839.80. Based upon a review of all documentation submitted, we have determined that you

were overpaid $123,839.80 for services that in whole or in part are not covered by Medicaid. A

fine of$49,535.92 has been applied. The cost assessed for this audit is $1,972.16. The total

amount due is $175,347.88.

Be advised of the following:

(1) In accordance with Sections 409.913(15), (16), and (17), Florida Statutes (F.S.), and

Rule 59G-9.070, Florida Administrative Code (F.A.C.), the Agency shall apply

sanctions for violations of federal and state laws, including Medicaid policy. This

letter shall serve as notice of the following sanction(s):

• A fine of$49,535.92 for violation(s) of Rule Section 59G-9.070(7) (e), F.A.C.

(2) Pursuant to Section 409.913(23) (a), F.S., the Agency is entitled to recover all

investigative, legal, and expert witness costs.

This review and the determination of overpayment were made in accordance with the provisions

of Section 409.913, F.S. In determining the appropriateness of Medicaid payment pursuant to

Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies,

limitations and requirements found in the Medicaid provider handbooks and Section 409.913,

F.S. In applying for Medicaid reimbursement, providers are required to follow the guidelines set

2727 Mahan Drive • Mail Stop #6 F acebo ok. com/AHCAFiorid a

Tallahassee, FL 32308 Youtube. com/AHCAFiorid a

AHCA. MyFiorida. com Twitter.com/AHCA FL

S lideShare. net/AHCAFiorida

Lazaro Miguel Garcia

376490700

C.I. No.: 14-1332-000

Page 2

forth in the applicable mles and Medicaid fee schedules, as promulgated in the Medicaid policy

handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay tbr

services that do not meet these guidelines.

Below is a discussion of the particular guidelines related to the review of your claims, and an

explanation of why these claims do not meet Medicaid requirements. The audit work papers are

attached, listing the claims that are affected by this determination.

REVIEW DETERMINATION{S)

1. The 2008 Florida Medicaid Provider General Handbook, pages 2-57 and 5-8, defines

incomplete records as records that lack documentation that all requirements or conditions

for service provision have been met. A review of your medical records revealed that

some services for which you billed and received payment were incomplete or the

documentation was not provided. Payments made to you for these services are considered

an overpayment. (No Doc., Insufficient Doc.)

2. The 2007 and 2010 Physician Services Coverage and Limitations Handbooks, pages 2-2

and 2-3, specify that Medicaid reimburses for services that are individualized, specific,

consistent with symptoms or confirmed diagnosis of the illness or injury under treatment,

not in excess of the recipient's needs, and reflect the level of services that can be safely

furnished. A review of your medical records by a peer consultant in accordance with

Sections 409.913 and 409.9131, F.S revealed that the level of service for some claims

submitted were not supported by the documentation. The appropriate code was applied

and the payment adjusted. Payments made to you for these services, in excess of the

adjusted amount, are considered an overpayment. (LOS)

3. The 2008 Florida Medicaid Provider General Handbook, page 5-4, states that when

presenting a claim for payment under the Medicaid program, a provider has an

affirmative duty to present a claim for goods and services that are medically necessary. A

review of your medical records by a peer consultant in accordance with Sections 409.913

and 409.9131, F.S revealed that the medical necessity for some claims submitted was not

supported by the documentation. Payments made to you for these services are considered

an overpayment. (NMN)

4. The 2007 and 2010 Physician Services Coverage and Limitations Handbooks, pages 2-

110 and 2-112 respectively, state that the maximum fee ibr radiology services includes

the professional component and the technical component. To be reimbursed the

maximum fee, the physician must provide both components. A review of your medical

records revealed that you billed and received payment for the maximum fee for services

when a physician outside of your group performed the professional component. The

payment was adjusted to the amount allowed for the teclmical component. Payments

made to you for these services, in excess of the adjusted amount, are considered an

overpayment. ere only)

Lazaro Miguel Garcia

376490700

C.I. No.: 14-1332-000

Page 3

5. The 2007 and 2010 Physician Services Coverage and Limitations Handbooks, page 2-98

respectively, describe an established patient as one who has received services from a

physician or provider in the same specialty within a group, within the past three years. A

review of your medical records revealed that some services rendered to the established

patients were billed and paid as new patient visits. The appropriate code was applied and

the payment adjusted. Payments made to you for these services, in excess of the adjusted

amount, are considered an overpayment. (Not new pt)

6. The 2007 and 2010 Physician Services Coverage and Limitations Handbooks, page 2-11 0

and 2-112 respectively, require that when a non-invasive radiological study is performed

in an office setting, the physician billing the maximum fee must either directly or

indirectly supervise the technical component of the study and perform the interpretation

and results of the study. The maximum fee includes the professional component and the

technical component of the radiological service. A review of your medical records

revealed that you billed and received payment for the maximum fee for services when the

professional component was performed by a radiologist outside of your group. Payments

made to you for these services are considered an overpayment. (Medicaid does not

reimburse in ofc. setting w/o PC & TC)

7. The 2008 Florida Medicaid Provider General Handbook, page 2-57, requires that the

author of each (medical record) entry must be identified and must authenticate the entry

by signature, written initials or computer entry. A review of your medical records

revealed that some services, for which you billed and received payment, were not

signature certified. Payments made to you for these services are considered an

overpayment. (No signature)

OVERPAYMENT CALCULATION

A random sample of 35 recipients respecting whom you submitted 346 claims was reviewed.

For those claims in the sample, which have dates of service from January 1, 2010, through

December 31, 2012, an overpayment of$5,117.16 or $14.78947977 per claim, was found. Since

you were paid for a total (population) of9,623 claims for that period, the point estimate of the

total overpayment is 9,623 x $14.78947977 = $142,319.16. There is a 50 percent probability

that the overpayment to you is that amount or more.

We used the following statistical formula for cluster sampling to calculate the amount due the

Agency:

E-t u(u -N)f(A; -YB;Y

N(N -1) i=l

Where:

E point estimate of overpayment F[ t A,/ t, B,]

Lazaro Miguel Garcia

376490700

C.I. No.: 14-1332-000

Page 4

u

F = number of claims in the population = L B;

i=l

A, = total overpayment in sample cluster

B, = number of claims in sample cluster

U = number of clusters in the population

N = number of clusters in the random sample

Y mean overpayment per claim t. A,/ t. B,

t = t value from the Distribution of t Table

All of the claims relating to a recipient represent a cluster. The values of overpayment and

number of claims for each recipient in the sample are shown on the attachment entitled

"Overpayment Calculation Using Cluster Sampling." From this statistical formula, which is

generally accepted for this purpose, we have calculated that the overpayment to you is

$123,839.80 with a ninety-five percent (95%) probability that it is that amount or more.

If you are currently involved in a bankruptcy, you should notify your attorney immediately and

provide a copy of this letter for them. Please advise your attorney that we need the following

information immediately: ( 1) the date of filing of the bankruptcy petition; (2) the case number;

(3) the court name and the division in which the petition was filed (e.g., Northern District of

Florida, Tallahassee Division); and, (4) the name, address, and telephone number of your

attorney.

If you are not in bankruptcy and you concur with our findings, remit by certified check in the

amount of$175,347.88, which includes the overpayment amount as well as any fines imposed

and assessed costs. The check must be payable to the Florida Agency for Health Care

Administration. Questions regarding procedures for submitting payment should be directed to

Medicaid Accounts Receivable, [phone]. To ensure proper credit, be certain you legibly

record on your check your Medicaid provider number and the C. I. number listed on the first page

of this audit report. Please mail payment to:

Medicaid Accounts Receivable - MS # 14

Agency for Health Care Administration

2727 Mahan Drive Bldg. 2, Ste. 200

Tallahassee, FL 32308

Pursuant to section 409.913(25)(d), F.S., the Agency may collect money owed by all means

allowable by law, including, but not limited to, exercising the option to collect money from

Medicare that is payable to the provider. Pursuant to section 409.913(27), F.S., if within 30 days

following this notice you have not either repaid the alleged overpayment amount or entered into

a satisfactory repayment agreement with the Agency, your Medicaid reimbursements will be

withheld; they will continue to be withheld, even during the pendency of an administrative

hearing, until such time as the overpayment amount is satisfied. Pursuant to section 409.913(30),

F.S., the Agency shall terminate your participation in the Medicaid program if you fail to repay

Lazaro Miguel Garcia

376490700

C.I. No.: 14-1332-000

Page 5

an overpayment or enter into a satisfactory repayment agreement with the Agency, within 35

days after the date of a final order which is no longer subject to further appeal. Pursuant to

sections 409.913(15)(q) and 409.913(25)(c), F.S., a provider that does not adhere to the terms of

a repayment agreement is subject to termination from the Medicaid program. Finally, failure to

comply with all sanctions applied or due dates may result in additional sanctions being imposed.

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

the petition must be made in compliance with rule Section 28-106.301, F.A.C. 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.

Section 409.913(12), F.S., provides exemptions from the provisions of Section 119.07(1), F.S. All

information obtained pursuant to this review is confidential and exempt from the provisions of

Section 119.07(1 ), F.S., until the Agency takes final agency action with respect to the provider and

requires repayment of any overpayment or imposes an administrative sanction by Final Order.

Any questions you may have about this matter should be directed to: Kris Creel, Investigator,

Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan Drive,

Mail Stop #6, Tallahassee, Florida 32308-5403, telephone [phone], facsimile (850)

410-1972.

Robi Olmstead

AHCA Administrator

Office of the Inspector General

Medicaid Program Integrity

RO/KC/jc

Enclosure(s)

Copies furnished to:

Finance & Accounting

(Interoffice mail)

Health Quality Assurance

(E-mail)

Lazaro Miguel Garcia

376490700

C.l. No.: 14-1332-000

Page 6

NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS

You have the right to request an administrative hearing pursuant to Sections 120.569 and

120.57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Audit Report

(hereinafter FAR), you may request a formal administrative hearing pursuant to Section

120.57(1), Florida Statutes. If you do not dispute the facts stated in the FAR, but believe there

are additional reasons to grant the relief you seek, you may request an informal administrative

hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, pursuant to Section

120.573, Florida Statutes, mediation may be available if you have chosen a formal administrative

hearing, as discussed more fully below.

The written request for an administrative hearing must conform to the requirements of

either Rule 28-106.201(2) or Rule 28-106.301(2), Florida Administrative Code, and must be

received by the Agency for Health Care Administration, by 5:00 P.M. no later than 21 days after

you received the FAR. The address for 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: [phone]

Phone: [phone]

E-File Website: http://apps.ahca.myflorida.com/Efile

Petitions for hearing filed pursuant to the administrative process of Chapter 120, Florida Statutes

may be filed with the Agency by U.S. mail or courier sent to the Agency Clerk at the address

listed above, by hand delivery at the address listed above, by facsimile transmission to (850)

921-0158, or by electronic filing through the Agency's website at

http://apps.ahca.myflorida.com/Efile.

The request must be legible, on 8 1 /:z by 11-inch white paper, and contain:

1. Your name, address, telephone number, any Agency identifYing number on the FAR, if

known, and name, address, and telephone number of your representative, if any;

2. An explanation of how your substantial interests will be affected by the action described

in the FAR;

3. A statement of when and how you received the FAR;

4. For a request for formal hearing, a statement of all disputed issues of material fact;

5. For a request for formal hearing, a concise statement of the ultimate facts alleged, as well

as the rules and statutes which entitle you to relief;

6. For a request for formal hearing, whether you request mediation, if it is available;

7. For a request for informal hearing, what bases support an adjustment to the amount owed

to the Agency; and

8. A demand for relief.

A formal hearing will be held if there are disputed issues of material fact. Additionally,

mediation may be available in conjunction with a formal hearing. Mediation is a way to use a

neutral third party to assist the parties in a legal or administrative proceeding to reach a

settlement of their case. If you and the Agency agree to mediation, it does not mean that you

give up the right to a hearing. Rather, you and the Agency will try to settle your case first with

mediation.

Lazaro Miguel Garcia

376490700

C.I. No.: 14-1332-000

Page 7

If you request mediation, and the Agency agrees to it, you will be contacted by the

Agency to set up a time for the mediation and to enter into a mediation agreement. If a

mediation agreement is not reached within 10 days following the request for mediation, the

matter will proceed without mediation. The mediation must be concluded within 60 days of

having entered into the agreement, unless you and the Agency agree to a different time period.

The mediation agreement between you and the Agency will include provisions tbr selecting the

mediator, the allocation of costs and fees associated with the mediation, and the confidentiality

of discussions and documents involved in the mediation. Mediators charge hourly fees that must

be shared equally by you and the Agency.

If a written request for an administrative hearing is not timely received you will have

waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes,

and the action set forth in the FAR shall be conclusive and final.

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY

• Complete s 1, 2, and 3. Also complete A. Signature

item 4 if R. .cted Delivery is desired.

• Print your name and address on the reverse

so that we can return the card to you.

• Attach this card to the back of the mailpiece,

Lazaro •Miguel Garcia ·r delivery address below:

3626 NW 7th Street

Miami, FL 33125

C. I.# 14-1332-000/PCU/KC/jc

o..). V'O'IVI\\..oQ type

M Certified Mail 0 Express Mail

0 Registered 0 Return Receipt for Merchandise

0 Insured Mail 0 C.O.D.

4. Restricted Delivery? (Extra Fee) 0 Yes

2. Article Number 7010 1060 0001 4601

(Transfer from service /abeQ

PS Form 3811, February 2004 Domestic Return Receipt 102595.02-M-1540 J

UNITED STATES POSTAL SERVICE First-Class Mail

USPS Postage & Fees Paid

l Permit No. G-10

. . .. . . '( .

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Jgency for Health Care Adtninis-tratlon

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REQUEST FOR FORMAL HEARING

Provider No. 3764907 00 2nu ocr 11 P 3: 4 o

License No. ME0067163 representative:-

Lazaro Miguel Garcia, M.D. Javier Banos, ESQ

3626 NW 7 Street 3126 Coral Way

Miami, Florida 33125 Miami, Fla. 331453210

[phone] fx [phone] [phone] fx (305)403-1 061

FAR: CI No 14-1332-000,

dated 9/04/2014

Please accept this document as my Respectful Request for a

Hearing, and do review the detailed comments below

A mediation over the issues will always be welcomed.

I DISPUTE that the random sample of35 patients was an accurate

representation of my practice and patient demographics; from

there I have NO choice but to DISPUTE the calculations using

Cluster Sampling, as per the Agency

As I understand AHCA' s mandate is to properly enforce the rules, safeguard

patient's health care and supervise improper services or billing; not act

indiscriminately assessing fines. The patients served by my office receive

the utmost care; our commitment to their wellbeing is unquestioned, and the

facts which we dispute, may be addressed in more detail, which will

ultimately result in the amending the FAR findings

It has taken time, to have my billing company's professional nursing staff,

ATTEMPT to review the Agency's COMMENTS on the patient care note

(see 3 sample enclosed), where they CAN NOT MAKE out de criticism and

discrepancies, as found by Agency's Staff

Further, I had separate Quality review personnel, and they also

found MOST, .... if not all!) of the Agency's comments and

critiques, IMPOSSIBLE, to decipher.

EXHIBIT 2

What is definitely true is that from a "brief35 patient review", by

technicians, a calculated overpayment of$ 5,117.18 was arrived at

(Agency's Overpayment Calculation Sheet-also enclosed)

and from that amount, it is extrapolated to$ 123,839.80, further

adding costs, and a fine of$ 49,535.92, totaling $ 175,347.88; an

amount IN EXCESS of most Physicians Annual Wages in Florida

There was no issue that patients had been seen, treated, treatment

supervised by a Physician at all times; and subsequent care and

visit were done .. and proper follow-up and documentation.

Seems like the character of the "audit" in one of "technical

deficiencies", if any!, since we COULD NOT definitely

understand what the critique and questions raised, are!!

The amounts involved, formulas by Agency (which CMS has

stopped using years ago!! !)only reflect the punitive nature of the

exercise, and in any reasonable case; would amount to financial

closure of the practitioner, and NO care to the State of Florida

patients requiring medical attention, at fees WELL below private

practice or private pay, fees!

I welcome the opportunity to at any level, to discuss my

commentaries in person, or mediate the FAR findings; but please

accept my request for a Formal Administrative Hearing to

safeguard my economic interest, since the patients were well

served, attention was given, costs have been suffered, and the FAR

findings would only result in unnecessary financial punishment, in

a small local practice to a needy population of Florida residents.

Dated at Miami, Florida this 1Oth day of October 2014

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY

FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs. C.I.: No. 14-1332-000

Provider No. 376490700

LAZARO MIGUEL GARCIA, NPI No. 1811203946

License No. ME67163

Respondent.

---------------------------- I

STIPULATION OF WITHDRAWAL

The Petitioner, Agency for Health Care Administration (a/k/a and hereinafter

"Petitioner", "AHCA" or "Agency"), and the Respondent, Lazaro Miguel Garcia (hereinafter

"RESPONDENT, or "PROVIDER") hereby file this Joint Stipulation of Withdrawal and state:

1. Respondent wishes to withdraw his Petition for Formal Hearing in the above

captioned action and does not object to the Agency entering a Final Order in the full amount of

the overpayment in the amount of one hundred ten thousand, nine hundred eighty eight dollars

and eighty cents ($11 0,988.80), plus costs in the amount of two thousand, three hundred sixty

four dollars and forty three cents ($2,364.43) and sanctions in the amount of forty four thousand

three hundred ninety five dollars and fifty two cents ($44,395.52) for a grand total amount due

and owing of one hundred fifty seven thousand, seven hundred forty eight dollars and seventy

five cents ($157,748.75).

2. The parties acknowledge that the Final Audit Report, dated September 4, 2014,

upon which these proceedings are based lists an overpayment, sanctions and costs in an amount

Exhibit 3

Filed with AHCA Agency Clerk 2/9/2016 3:08:07 PM

greater than those amounts listed above. The parties acknowledge and agree that the $157,748.75

listed herein is the amount outstanding and due. The difference in the amount of the Final Audit

Report and the amount listed herein is due to re-reviews of outstanding claims in the audit based

upon additional documentation and information Respondent submitted to the Agency.

3. Said withdrawal shall act to waive Respondent's rights to a Final Formal Hearing

regarding the Final Audit Report dated September 4, 2014.

Respectfully submitted on this the 9th day of February 2016.

/s/ Javier Banos /s/ James Ross

Javier Banos, Esquire James Ross, Esquire

Counsel for Respondent Associate General Counsel

3126 Coral Way Florida Bar No. 0059461

Miami, Florida 33145 Agency for Health Care Administration

Telephone: [phone] Telephone: [phone]

[e-mail] 2727 Mahan Drive, MS #3

Tallahassee, Florida 32308

Telephone: [phone]

Facsimile: [phone]

J [e-mail]

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was served to the

individuals named below by the method designated on this 9th day of February 2016.

/s/ James Ross

James Ross

Javier Banos, Esquire

Law Offices of Javier Banos, P.A.

[e-mail]

jbanos(mlawservices.us

(by electronic mail)

Filed with AHCA Agency Clerk 2/9/2016 3:08:07 PM