16-003817MPI Agency For Health Care Administration vs. Lee Memorial Health System Gulf Coast Medical Center Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, June 20, 2019.

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1- L i", 1

STATE OF FLORIDA 2020 MAY 12 A P- 1- 06

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA AGENCY

FOR HEALTH CARE ADMINISTRATION, DOAH CASE NO.: 16- 3817MPI

MPI C. I. NO.: 13- 0104- 000

Petitioner, MPI CASE NO.: 2015- 0001967

PROVIDER ID NO.: 011134100

i111P NPI NO.: 1982658407

LICENSE NO.: 4301

LEE MEMORIAL HEALTH SYSTEM RENDITION NO.: AHCA-` u - - 7 - S- MDO

GULF COAST MEDICAL CENTER,

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. Based on the

foregoing, this file is CLOSED.

DONE and ORDERED on this the d- ay of , 2020, in Tallahassee,

Florida.

Agency for Health Care Administration

Agency for Health Care MPI Administration Case No.: 2015- vs. Lee 0001967 Memorial C. I. Health No.: 13- System 0104- Gulf 000 Coast Medical Center

Final Order

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.

Copies furnished to:

Lee Memorial Health System Joanne B. Erde, Esquire

Gulf Coast Medical Center DUANE MORRIS LLP

P. O. Box 150107 201 S. Biscayne Boulevard

Cape Coral, Florida 33915- 0107 Suite 3400

U. S. Mail) Miami, Florida 33131

j erde( iT, duanemorri s. com

Electronic Mail)

Kelly Bennett, Chief, MPI Division of Health Quality Assurance

Electronic Mail) Bureau of Central Services

CSMU- 86gahca. myflorida. com

Stefan R. Grow, Esquire Division of Health Quality Assurance

General Counsel Bureau of Health Facility Regulation

Electronic Mail) BHFR( aahca. myflorida. com

Electronic Mail)

Shena L. Grantham, Esquire Bureau of Financial Services

MAL & MPI Chief Counsel Electronic Mail)

Electronic Mail)

Joseph G. Hem, Esquire Medicaid Fiscal Agent Operations

Counsel for AHCA Electronic Mail)

Joseph. Hemgahca. myflorida. com

Electronic Mail)

Agency for Health Care MPI Administration Case No.: 2015- vs. Lee 0001967 Memorial C. I. Health No.: 13- System 0104- Gulf 000 Coast Medical Center

Final Order

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 U. S. Mail or other designated method on this therday of

2020.

Rich oop, ire

Agency Clerk

State of Florida

Agency for Health Care Administration

2727 Mahan Drive, MS # 3

Tallahassee, Florida 32308- 5403

850) 412- 3689/ FAX ( 850) 921- 0158

Agency for Health Care MPI Administration Case No.: 2015- vs. Lee 0001967 Memorial C. I. Health No.: 13- System 0104- Gulf 000 Coast Medical Center

Final Order

Page 3 of 3

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner C. I. NO.: 13- 0104- 000

PROVIDER NO.: 011134100

NPI NO.: 1982658407

LICENSE NO.: 4301

LEE MEMORIAL HEALTH SYSTEM MPI CASE NO.: 2015- 0001967

GULF COAST MEDICAL CENTER,

Respondent.

SETTLEMENT AGREEMENT

Petitioner, the STATE OF FLORIDA, AGENCY FOR HEALTH CARE

ADMINISTRATION (" AHCA" or " Agency"), and Respondent, LEE MEMORIAL HELATH

SYSTEM GULF COAST MEDICAL CENTER (" PROVIDER'), by and through the

undersigned, hereby stipulate and agree as follows:

1) The parties enter into this agreement for the purpose of memorializing the resolution

of this matter.

2) PROVIDER is a Medicaid provider in the State of Florida, provider number

011134100, and was a provider during the audit period.

3) In its Final Audit Report ( attached as Exhibit A), dated June 3, 2016, the Agency

notified PROVIDER that a review of Medicaid claims performed by the Agency' s Bureau of

Medicaid Program Integrity (" 1VI n during the period of January 1, 2008, through December 31,

2008, indicated that certain claims, in whole or in part, were inappropriately paid by Medicaid.

The Agency sought repayment of this overpayment, in the amount of one hundred thirty- six

thousand, eight hundred ninety- one dollars and seventeen cents ($ 136, 891. 17). Additionally, the

AHCA vs. Lee Memorial Health System Gulf Coast Medical Center

C. I. No.: 13- 0104- 000; MPI Can No.: 2015- 0001967

SoWement Agreemem

Page 1 of 6

Agency applied costs in the amount of ten thousand, four hundred dollars and twenty cents

10, 400. 20) pursuant to section 409. 913( 23xa), Florida Statutes. The total amount due was one

hundred forty- seven thousand, two hundred ninety- one dollars and thirty- seven cents

147, 291. 37).

4) In response to the Final Audit Report dated June 3, 2016, PROVIDER filed a Petition

for Formal Administrative Hearing.

5) On July 28, 2016, and several dates thereafter, an Order was issued placing the case

in abeyance during the litigation of Lee Memorial Health System Gulf Coast Medical Center v

Agency forHealth Care Administration, DOAH Case No. 15- 3876, First District Court of Appeal

Case No. 1D16- 1969 rGulf Coast', ARCA v Lee Memorial Health System dGla Lee Memorial

Hospital, Case No. 14- 4171MP1 & 15- 3271MP1, First DCA No. ID] 6 3975 ( lee Memorial) and

AHCA v. Cape Memorial Hospital, Inc. d/ bla Cape Coral Hdspital, Case No. 14- 3606MP1, First

DCA No. 1D16- 5310 ( Cape Memorial). On February27, 2019, the First District Court of Appeal

issued its Opinion in the cases mentioned above finding in favor of the hospitals. The Mandate

for each case was issued on June 18, 2019.

6) In light of the ruling of the First District Court of Appeal, PROVIDER and AHCA

agree as follows:

i) The Final Audit Report dated June 3, 2016 is rescinded

ii) As of the date of this Settlement Agreement, AHCA has collected

monies from PROVIDER totaling one hundred forty- seven thousand,

two hundred ninety- one dollars and thirty- seven cents ($ 147, 291. 37)

the Refund Amount").

iii) Within thirty ( 30) days of AHCA' s receipt of this Settlement Agreement

AHCA vs. % e Memorial Health System Gulf Coast Medical Center

C. I. No.: 13- 0104- 000; MPI Case No.: 2015- 0001967

Settlement Agm= ent

Page 2 of 6

executed by PROVIDER, AHCA shall issue a Final Order adopting this

Settlement Agreement.

iv) Within fifteen ( 15) days following issuance of a Final Order, the

Revenue Section of AHCA' s Financial Services (" Financial

Services") shall forward PROVIDER a Refund Application reflecting

the refund of one hundred forty- seven thousand, two hundred ninety-

one dollars and thirty- seven cents ($ 147, 291. 37) due to PROVIDER.

v) Once AHCA' s Financial Services section has received a complete,

correct, and original signed Refund Application, the Refund Application

will be processed and transmitted to the Department of Financial

Services within fifteen days of receipt.

vi) Payment of the refund shall be made within thirty ( 30) days of Financial

Services' submission of and the Florida Department of Financial

Services' (" DFS") approval of the signed Refund Application.

7) PROVIDER and AHCA agree that full payment, as set forth above, resolves and

settles this case completely and releases both parties from any administrative or civil liabilities

arising from the findings referenced in audit C. I. Number 13- 0104- 000 ( MPI Case No.: 2015-

0001967).

8) AHCA and PROVIDER reserve the right to enforce this Agreement under the laws

of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and

regulations.

9) This settlement does not constitute an admission of wrongdoing or error by either

party with respect to this case or any other matter.

ARCA vs. Lee Memorial Health System Gulf Coast Medical Center

C. L No.: 13- 0104000; MPT Case No.: 2015- 0001967

Settlement Agreement

Page 3 of 6

10) The signatories to this Agreement, acting in a representative capacity, represent that

they are duly authorized to enter into this Agreement on behalf of the respective parties.

11) 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.

12) This Agreement constitutes the entire agreement between PROVIDER and AHCA,

including anyone acting for, associated with, or employed by the parties, concerning this matter

and supersedes any prior discussions, agreements, or under standiags. There are no promises,

representations, or agreements between PROVIDER and AHCA other than as set forth herein. No

modification or waiver of any provision shall be valid unless a written amendment to the

Agreement is completed and properly executed by the parties.

13) This is an Agreement of Settlement and Compromise, made in recognition that the

parties may have different or incorrect understaadiags, 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.

14) PROVIDER expressly waives in this matter its right to any hearing pursuant to

sections 120. 569 or 120. 57, Florida Statutes; the making of findings of fact and conclusions of

law by the Agency; all fWther and other proceedings to which it may be entitled by law or rules

of the Agency regarding this proceeding; and any and all isaues raised herein so long as payment

of the Refund Amount is made in accordance with the terns of this Settlement Agreement as set

forth herein. PROVIDER finther agrees that it shall not challenge or contest any Final Order

entered in this matter, which is consistent with the terms of this Settlement Agreement in any

forum now or in the future available to it, including the right to any administrative proceeding,

ARCA vs. Lee Memorial Health System Gulf Coast Medical Center

C. I. No.: 13- 0104- 000; MPI Case No.: 2015- 0001967

Settlennt Agmement

Page 4 of 6

circuit or federal court action, or any appeal.

15) PROVIDER does hereby discharge the State of Florida, Agency for Health Care

Administration, and its employees, agents, representatives, and attorneys of and from all claims,

demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature

whatsoever, arising out of or in any way related to this matter, AHCA' s actions herein, including,

but not limited to, any claims that were or may be asserted in any federal or state court or

administrative forum, including any claims arising out of this agreement except that PROVIDER

reserves its rights to enforce the provisions of this Settlement Agreement.

16) The parties agree to bear their own attorney' s fees and costs.

17) This Agreement is and shall be deemed jointly drafted and written by all parties to it

and shall not be conshued or interpreted against the party originating or preparing it.

18) To the extent that any provision of this Settlement Agreement is prohibited by

law for any reason, such provision shall be effective to the extent not so prohibited, and such

probibition shall not affect any other provision of this Agreement; provided, however, that in the

event that payment is not made to PROVIDER as set forth herein, this entire Settlement Agreement

is null and void and Provider retains its rights to bring any actions necessary to recoup the Refund

Amount set forth herein.

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

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

20) All times stated herein are of the essence of this Agreement.

21) This Agreement shall be in full force and effect upon execution by the respective

parties in counterpart.

ARCA vs. Lee Memorial Health System Gulf Coast Medical Center

C. T. No.: 13- 0104- 000; MPI Case No.: 2015- 0001967

Settlement Agreement

Page 5 of 6

LEE MEMORIAL HEALTH SYSTEM

GULF COAST MEDICAL CENTER

Date: V,&, A ( 1 , ZttT9 o • a

Signed) Au esentative of

LEE MEMOWAL HEALTH SYSTEM

GULF COAST MEDICAL CENTER

Print Name andTitle

Date: . 2019

DUANE MORRIS LLC.

Attorney for Provider Signature

BY:

Print Name)

AGENCY FOR HEALTH CARE ADMINISTRATION

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

Tall Fee, FL 308- 5403

Date. - l/ – Zv , atg--

o11y try

Deputy Secretary for HQA

7-- 1t Date:

Stefan R. w, Esquire

General Counsel

Wzotdl Date: 4/ 29 20K

Shena L. Granth Esquire

MAL & MPI Chief Counsel

Zc

Date: 1% 4- # "-. —, 20 0

Joseph G. Han, Esquire

Medicaid Admin. Litigation

Counsel

AHCA vs. Lee Memorial Health System Gulf Coast Medical Center

C. I. No.: 13- 0104- 000; MPI Case No.: 2015- 0001967

Settlement Agreement

Page 6 of 6

RICK SCOTT

GOVERNOR

E_ IZABEIH DUDEK

SECRETARY

CERTIFIED MAIL No.: 91 7199 9991 7033 2219 5699

lune 3. 2016 EXHIBIT

a

Provider No.: 01 1 134100 3

NPI No.: 1982658407

License No.: 4301

LEE MEMORIAL HEALTH SYSTEM

G[ 1IT COAS' I' MEDICAL CE, NTF R

PO BOX 150107

CAPF', CORAL. 1- 1, 33915- 0107

In Reply Refer to

FINAL AUDIT REPORT

C. I.: No. 13- 0104- 000 or MPI Case ID: 2015- 0001967

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. 2008. through December 31. 2008. A preliminary audit report

dated September 25. 2015 was sent to you indicating that we had determined you were overpaid

242. 604. 39. Based upon a review of all documentation submitted. we have determined that you

were overpaid 5136. 891. 17 for claims that in whole or in part are not covered by Medicaid. The

cost assessed for this audit is 510. 400. 20. ' I' he total amount due is S147. 291. 37.

Be advised of the followine:

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 determinations of overpayment were made in accordance with the provisions

of' Section 409. 913. F. S. In determining payment pursuant to Medicaid policy, the Medicaid

program utilizes descriptions, policies and the limitations and exclusions found in the Medicaid

provider handbooks. In applying for Medicaid reimbursement, providers are required to follow

the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the

Medicaid policy handbooks, bulletins. and the Medicaid provider agreement. )\\- Medicaid cannot

pay for services that do not meet these guidelines.

2717 Mahan Drive • Mal! Stop 45 Facebook Youtube com/ conn/ AHCAFIonda AHCAFlor da

Tallahassee, FL 323o8 Twitter com/ AHCA_ FL

ARCA MyFlonda com 7

Sl, deShare net/ AHCAFlorida

Pro% idea. I {.{ N41-'% IORIAI HL:% I It! S1 5I I

Pro% idcr No : 01 I I ,-? 100

I- do - 13- 010. 4- 000 or N111 ( a, c 11). 2015- 000 N')-,

Emergency Medicaid for Aliens ( FMA) is a Medicaid limited coyeragc program in which coverage

is only for the duration of the emergency. Definitions for Lmergency Medical Condition.

Fanergency Services and Care or Medical Necessity. may he found in the Florida, Medicaid

Prodder _ General Handbook. Other relevant definitions maN be found in the Florida

Administrative Codes. Florida Statutes and in federal law.

Belo`, is a discussion of the particular guidelines related to the review of EM. A claims and an

explanation of why these claims do not meet Medicaid requirements. A list of the paid claims

affected by this determination is attached.

REVIEW DETERMINATION( S)

I lie Medicaid Provider General Handbook( s) 2007. page 3- 19. and 2008. page 3- 22, establish

Limited Coverage Categories and Program Codes for programs with limited Medicaid benefits.

Medicaid policy related to the program. Emergence Medicaid for Aliens. is further described. The

Hospital Services Coverage and limitations Handbook. 2005. page 2- 7, also refers to Emergency

Medicaid for Aliens policy. These policy references state: " Eligibility can be authorized only for

the duration of the emergency. Medicaid will not pay for continuous or episodic services after the

emergency has been alleviated.' Medicaid Provider Reimbursement }- landbook UB - 04. 2007 page

2- 7 states: " Medicaid coverage of inpatient services for non- qualified. non - citizens is limited to

emergencies. newborn delivery services and dialysis sery, ices."

A medical record review was performed by a medical review team including a peer physician

reviewer who determined the point at which the alien recipient' s emergent complaint was

alleviated. Medicaid policy does not allow payment of claims for services rendered beyond the

date the emergency has been alleviated. Although medical necessity may continue to exist.

Medicaid is not responsible for payment of those continuing services. Consequently, the inpatient

services billed to and paid by Medicaid beyond the peer reviewers determined date of alleviation

are identified as an overpayment and are subject to recoupment.

In instances where hospital observation days were allowed. claims were adjusted to allow the

outpatient per diem for observations, and the difference was identified as an overpayment and

subject to recoupment.

In instances where the medical record was not received or was incomplete. the related claim was

denied. The Medicaid Provider General handbook s . 2007 and 2008. page 5- 8, state the

following:

Incomplete records are records that lack documentation that all requirements or conditions

for service provision have been met. Medicaid may recover payment for services or goods

when the provider has incomplete records or cannot locate the records."

1' ro ider: l. laF MINIORIA1 III Al III SYSI1 % 1

Prov ider No -: 0l 1114100

t . l. A(,_' 13- 0104- 000 of \\ 11' 1 ( arc 11). '- 0j-;- 000j907

1' ger ;

The Medicaid Provider_ General Handbook( sL 2007 and 2008. page 5- 1. defines " Overpa) ment"

as:

Overpayment includes 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 claims.

unacceptable practices. fraud. abuse. or mistake."

If you are currently involved in a bankruptcy. you should notif} \\' our attorney immediately and

then provide them a copy of this letter. Please advise \\' our attorney that we require 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):

41) the name. address. and telephone number of your attorney.

If you are not in bankruptcy and you concur with our findings. remit payment by certified check

in the amount of S147. 291, 37. which includes the overpayment and assessed costs.

The check must be payable to the Florida Agency for Health Care Administration.

To ensure proper credit. be certain you legible 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 (' are Administration

2727 Mahan Drive Bldg. 2. Ste. 200

1 allahassee. FI_, 32308

Questions regarding procedures for submitting payment should be directed to Medicaid . Accounts

Receivable. ( 850) 412- 3901.

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. The Final Audit Report constitutes a probable cause

determination by the Agency that you were overpaid by the Medicaid program. Thus, 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 tirne as the overpayment amount is

satisfied. Pursuant to section 409. 913( 30). 1-. 5.. the Agency shall terminate your participation in

the Medicaid program if _ you fail to repay 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. 9L3( 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.

Prodder. Lt F MGMORIAI ItVA[ . I II SYI 1I IA1

Ilio% ider No. : 011134100

C. I_ No,: 13- 0104- 000 or MPI Case 11) 2015- 000190;

Page 4

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 for

the complaint and all information obtained pursuant to an investigation of a Medicaid provider

relating to an allegation of fraud. abuse, or neglect. The Agency has made the determination that

your violation( s) of Medicaid policy constitute abuse as referenced in Section 409. 913, F. S. Thus.

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

Section 1 19. 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: Mechelle Davis. AIfCA

Investigator. Agency for Health Care Administration. Office of Inspector General. Medicaid

Program Integrity. 2727 Mahan Drive. Mail Stop 46. Tallahassee. Florida 32308- 5403. telephone:

850) 412- 4600, facsimile: ( 850) 410- 1972.

Sincerely.

Ken Yon. Assistant Chief

Office of Inspector General

Medicaid Program Integrity

KY/ MD/ kj

Enclosure( s): Provider Overpayment Remittance Voucher

Notice of Administrative Hearing and Mediation Rights

Paid Claims Report

Medical Peer ReviexN Worksheets

Copies furnished to: Finance & Accounting ( Interoffice mail)

Health Quality Assurance ( F - mail)

Propidcr. LI:[ % 11 % 1O IA1 III Al III til` 5i 1= N1

Prov ilei No, : 01 1 1 34 100

1. No., 13- 0104- 000 of % 1P1 ( arc II): 201- 000190"

Parc

Final Audit Report ( FAR)

Provider Overpayment Remittance Voucher

If you choose to make payment. please return this form along with your check.

Complete this form and send along with your check to:

Medicaid Accounts Receivable - MS r 14

Agency for Health Care Administration

2727 Mahan Drive Bldg. 2. Ste. 200

Tallahassee. Il- 32308

CHECK MUST BE MADE PAYABLE TO: FLORIDA AGENCY FOR HEALTH CARE

ADMINISTRATION ION

Provider Name: I. EE, MEMORIAL HEAL" I' H SYSTEM

Provider 1D: 01 1 134100

MPI C. I. #: 13- 0104- 000

MPl Case ID: 2015- 0001967

Overpayment Amount: S 136. 891. 17

Costs: S l 0. 400. 20

Total Due: 5147. 291. 37

Check Number: #

A final order will be issued that will include the final identified overpayment and assessed costs.

taking into consideration any information or documentation that you have already submitted.

Any amount due will be offset by any amount already received by the Agenev in this

matter.

Payment for Medicaid Program Integrity Audit

Pro% idcr, I_ I I NII MORIAI IIIAtIII IAI

Prov idcr No. 01 If X4100

11vo 13- 0104- 000 or \\ 1111 ( arc 11): ? 0I4;- o0N9(,"

Page h

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 ma) 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. 20. 5- 73-

Florida Statutes. mediation maN be available if you have chosen a formal administrative hearinu. as discussed 57Florida 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. 501( 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 atter you received the FAR. The address for filing the sritten

request for an administrative hearing is:

Richard J. Shoop, Esquire

Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop # i 3

Tallahassee, Florida 32308

Fax: ( 850) 921- 0158 and Phone: ( 850) 412- 3630

E - File Website: http: l/ apl) s. ahca. mynorida. 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 E - File website at listed above.

The request must be legible. on 8' r_ by I I - inch \\ hite paper, and contain:

I . Your name. address, telephone number. any Agency identifying number on the FAR. if known. and name.

address.. and telephone number of' your representative, if am

2. An explanation of hos\\ your substantial interests will be affected bs 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.

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 for 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.