16-007367MTR Lolita Davis And Rickey Odonoven Davis, Individually And As Parents And Natural Guardians Of Rickey Davis, A Minor vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Friday, February 1, 2019.

Summary: In the absence of any evidence from AHCA to refute or contradict Petitioners' expert, Petitioner proved by a preponderance of the evidence that ACHA's Medicaid lien should be reduced to $11,657.56.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

LOLITA D. AND RICK EY O. D. ,

individually and as parents and

n atural guardians of RICKEY D. ,

a minor,

Petitioners,

vs. Case No. 16 - 7367MTR

AGENCY FOR HEALTH CARE

ADMINISTRATION,

Respondent.

_________________ ______________/

FINAL ORDER

A final hearing was held in this case by video

tele conference in Tallahassee and Miami, Florida, on December 4,

2018, before Robert L. Kilbride, an Administrative Law Judge of

the Division of Admi nistrative Hearings ( " DOAH " ).

APPEARANCES

For Petitioner: Floyd B. Faglie, Esquire

Staunton and Faglie, P.L.

189 East Walnut Street

Monticello, Florida 32344

For Respondent: Elizabeth A. Teegen, Esquir e

Office of the Attorney General

The Capitol , Plaza Level 01

Tallahassee, Florida 32399

STATEMENT OF THE ISSUE

What is the proper amount of Petitioners ' personal injury

settlement payable to Respondent, Agency for Health Care

Administration ( " AHCA " ), to satisfy AHCA ' s $51,130.05 Medicaid

lien under section 409.910(17)(b) , Florida Statutes .

PRELIMINARY STATEMENT

On December 9, 2016 , Petitioners filed a p etition with DOAH

for a hearing pursuant to s ect ion 409 .910(17)(b) to contest the

amount of AHC A ' s Medicaid lien.

The case was placed in abeyance whi le other courts resolved

legal issu es in various other cases related to s ection 409.910.

On May 3, 2018, the abeyance was lifted by the undersigned,

and the matter was set for hearing on July 10, 2018. However,

Petitioners ' attorney, Harold Knecht ( " Knec h t " ) , withdrew from

representation shortly before the hearing, and the hearing was

continued.

The final h earing was reset for December 4, 2018. On

N ovember 14, 2018, Petitioners filed a Motion for Leave to Amend

the Petition, which was granted.

Prior to the December 4, 2018 , final h earing the parties

filed a Joint Pre - hearing Stipulation ( " JPHS " ), which included

numerous stipulated issues of law and fact. Those stipulated

issues of law and fact are adopted and incorporated herein.

( Minor changes were made to the parties' stipulated facts to

insure consistency herein and to properly identify the parties. )

At the final hea ring , one witness was c alled. Petitioner s

called attorney Jorge C. Borron ( " Borron " ) as an expert witness.

Petitioners ' Exhibits 1 through 9 were admitted. AHC A called no

witnesses and offered no exhibits.

Unless othe rwise noted, all references to s ection 409.910

are to t he 2014 version of the statute, as agreed by the parties.

A T ranscript of the proceedings was filed with DOAH on

December 19, 2018. After being granted an extension, the parties

timely filed their respective proposed final o rders. Both

parties ' pro posed final o rders were reviewed and considered by

the undersigned in the preparation of this Final Order.

The parties requeste d that the Final Order be issued without

reference to the parties' full names .

FINDING S OF FACT

Based on the stipulatio ns of the parties, the evidence

presented at the hearing , and the record as a whole, the

following findings of fact are made:

1. On January 31, 2007, R ickey D. ( " Rickey " ), who was then

four years old, was struck by a car outside an apartment complex.

Rickey suffered severe life - threatening injuries , including a

fractured femur, fractured skull , and a close d head injury with

traumatic brain damage. JPHS, pp. 9 and 10 , ¶ 1 .

2. Rickey ' s medical care related to the injury was paid

by Medicaid. M edicaid provided $51,130.05 in benefits associated

with Rickey ' s injury. The $51,130.05 constituted Rickey ' s entire

claim for past medical expenses. JPHS , p . 10 , ¶ 2 .

3. Rickey ' s parents and natural guardians, Lolita D. and

Rickey O.D., brought a p ersonal injury claim against the

driver/owner of the car that caused the accident and the

apartment complex where the accident occurred ( " Defendants " ).

They sought recovery of all of Rickey ' s damages associated with

his injuries, as well as their own indiv idual damages associated

with their son ' s injuries. JPHS, p . 10 , ¶ 3; Pet. Ex. 4 .

4. The personal injury action was settled for a lump sum,

unallocated amount of $285,000.00 , which consisted of $275,000.00

paid by the apartment complex and $10,000.0 0 in bodily

injury/uninsured motorist ("BI/UM") insurance policy limits paid

by the driver. 1/

5 . The c ircuit c ourt in Miami - Dade County approved the

minor ' s settlement by entry of an Order Approving Settlement ,

dated February 2, 2014. 2/ JPHS , p . 1 0 , ¶ 4 and ¶ 5; Pet. Ex. 5 .

6. As a condition of Rickey ' s eligibility for Medicaid,

Petitioners' assigned to AHCA their right to recover f rom liable

third parties medical expenses paid by Medicaid. See 42 U.S.C.

§ 1396a(a)(25)(H) and § 409.910(6)(b ), Fla. Stat.

7. During the pendency of Petitioners' lawsuit, AHCA was

notified of the court action. JPHS, p . 10, ¶ 6 .

8. AHCA did not commence a civil action to enforce its

rig hts under section 409.910, or intervene or join in

Petitioners' co urt action against the Defendants. 3/ JPHS, p . 10 ,

¶ 7 .

9. Instead, AHCA asserted a $51,130.05 Medicaid lien

against Petitioners' cause of action and settlement of that

action. JPHS , p . 10 , ¶ 6 .

10. AH CA did not file a motion to set aside, vo id , or

otherwise dispute Petitioners' settlem ent with the Defendants.

JPHS , p . 10 , ¶ 8 .

11 . The Medicaid program spent $51,130.05 on behalf of

Rickey, all of which represents expenditures paid for Rickey ' s

past medical expenses. JPHS , p . 10 , ¶ 9 .

12. Application of the formula at section 409.910(11)(f) to

Rickey ' s $285,000.00 settlement requires payment to AHCA of the

full $51,130.05 Medicaid lien. JPHS , p . 10 , ¶ 10.

13 . As ordered by the circuit c ourt, Petitioner s deposited

the full M edicaid lien amount in an interest bearing account for

the benefit of AHCA pending an administrative determination of

AHCA ' s rights. This constitutes " final agency action " for

purposes of chapter 120, Florida Statutes, pursuant to

section 409.910(17). JP HS , p . 11 , ¶ 11 .

Testimony of Jorge C. Borron , Esquire

14. The only witnes s called during the hearing was Borron .

He has been a trial attorney for 32 years and is a sole

practitioner at his Coral Gables law office, Jorge C. Borron,

LLC.

15. The majority of Borron ' s practice is personal injury

litigation with a focus on car accidents. He ha s handled cases

involving injuries to children.

16. He routinely handles jury trials, and depending on the

year , will have two to four jury trials each year.

17. Borron stays current regarding personal injury verdicts

by reviewing jury verdict reporters and discussing personal

injury verdicts and valuations with other attorneys in his

geographical area.

18. After taking a case, Borro n regularly reviews and

studies his client ' s medical records and deposes/interviews

doctors and other experts concerning his client ' s injuries.

Borron testified that as a routine part of his practice he makes

assessments concerning the value of personal i njury damages

suffered by his clients.

19. Petitioner s proffered Borron as an expert in the

valuation of damages. It is worth noting that AHCA did not voir

dire Borron and did not object to his tender as an expert in the

valuation of personal injur y damages. 4/ The undersigned ruled

that he would consider Borron ' s opinion testimony on the subject

of the valuation of damages. 5/

20. Borron represented Rickey and his family in the

underlying personal injury lawsuit. Originally, A ttorney Knecht

represented Rickey and his family, but Knecht brought Borron into

the case in 2013 to handle the jury trial due to Knecht ' s

advanced age.

21. As a part of his representation, Borron reviewed and

familiarized h imself with the accident report and Ric key ' s

medical records, deposed/interviewed experts and fact witnesses,

and met with Rickey and his family numerous times.

Rickey ' s Accident, Injuries , and Prognosis

22. On January 31, 2007, young Rickey followed his older

sister out of the apartmen t where they lived with their parents.

He walked between two cars in the parking lot and darted out in

fr ont of a car , which struck him .

23. In the accident , Rickey suffered a compound fracture of

his femur, a skull fracture, a traumatic brain injur y , and lost

consciousness. Rickey was transported to Jackson Memorial

Hospital where he received medical treatment until he was

discharged on February 22, 2007.

24. At the hospital, his discharge papers diagnosed him

with a l eft comminuted femu r fr acture and a nondisplaced skull

fracture. Pet. Ex. 2 .

25. Rickey ' s injury had a tremendous impact on his life.

Besides the adverse physical effects from his femur fracture,

Rickey suffers from the effect s of a traumatic brain injury with

cognitive d eficits, abnormal behavior issues , and an attention

deficit disorder.

26. During his representation of Rickey , Borron sent his

client to two neurologists. They both separately diagnosed

Rickey with problems associated with the executive function in

the frontal lobe of his brain.

27. Dr. Jorge A. Herrara issued a detailed report and

concluded, among other things, that Rickey ' s condition points " to

the presence of impairments in the executive functions mediated

by the frontal lobes (r eferring to Rickey ' s brain). " Pet. Ex. 2,

p . 14 .

28. The other neurologis t, Dr. Ross, conducted an

electrocardiograph with abnormal results. The uncontroverted

evidence revealed that Rickey ' s traumatic brain injury is

permanent and he will suffer its adverse effects and cer tain

health and emotional - related issues for the remainder of his

life.

29. Based on his training, experience , and knowledge of the

case , it was Borron ' s opinion that Rickey ' s personal injury

damages had a value of between $1,500,000. 00 to $2,500,000.00.

30. In preparation for settlement mediation in the

underlying personal injury case, Borron undertook to estimate the

value of Petitioners' claim for future medical expenses as well.

31. He consulted with Rickey ' s neurolog ists concerning his

prognosis to determine what kind of medical treatment he would

need in the future. Based on these discussions, Borron estimated

that Rickey would need $815,000.00 in medical care from age nine

(his age at the time of mediation) until a ge 22.

32. In Borron ' s opinion, adding the $815,000.00 for future

medical expenses to Rickey ' s $51,130.05 claim for past medical

expenses would constitute Rickey ' s total economic damages.

33. Borron opined that the claim for economic damages added

to Petitioners' claim for noneconomic damages would push the full

value of Rickey ' s personal injury damages to the range of

$1,500,000.00 to $2,500,000.00.

34. Had the case not settled and a trial taken place ,

Borron testified that he would have expected a jury to determine

the value of Rickey ' s damages to be at , or between , $1,500,000.00

to $2,500,000.00.

35. Borron discussed Petitioners' case with A ttorney Knecht

and consulted with several other attorneys. They concurred that

Ricke y ' s personal injury damages had a value of between

$1,500,000.00 to $2,500,000.00.

36 . Borron testified that using $1,250,000.00 as the

estimated value of all Rickey ' s personal injury damages would be

a conservative value .

37 . Due to defenses r aised and issues of disputed liability

with the apartment complex, the case against the apartment

complex settled just prior to trial for $275,000.00 , plus a

$10,000.00 settlement with the insurance company for uninsured

motorist coverage, for a total set tlement of $285,000.00.

38. The uncontroverted evidence revealed that the combined

settlement of $285,000.00 received by Petitioners did not full y

compensate Rickey for the value of his damages.

39. Borron opined that in using the value of al l Rickey ' s

damages of $1,250,000.00 compared to the $285,000.00 settlement,

that the total settlement amount recovered represented a

proportional recovery of 22.8 percent of the true value of all

Rickey ' s personal injury damages.

40. Borron testifie d that because Rickey only recovered

22.8 percent of the true value of his damages in the global

settlement, that Petitioners had likewise recovered only

22.8 percent of Rickey ' s claim for past medical expenses in the

settlement agreement , or $11,657.66.

41. Borron testified that an allocation of $11,657.66 of

the $285,000.00 settlement as recovery for Rickey ' s past medical

expenses would be a reasonable and fair allocation.

42. Of particular consequence to this case, AHCA did not

call any ex pert witnesses nor did it p resent any evidence to

rebut Petitioners ' presentation, proof , or proposed allocation of

$11,657.66 to past medical expenses.

43. AHC A did not dispute or present any persuasive evidence

or arguments that Rickey ' s injuries were overstated or

incorrectly described by Borron.

44. On AHC A ' s cross - examination of Borron, the methodology

used by Borron to arrive at his opinion concerning a fair

allocation of past medical expenses was not challenged or

persuasively overcome b y AHC A.

45. Simply put, the amoun t of $11,657.66 proposed by

Petitioners as a fair allocation of past medical expenses from

the settlement agreement was u nrefuted and unchallenged by AHC A.

46. Petitioner s proved by a preponderance of the evidence

that $11,657.66 was a fair allocation of the total settlement

amount to past medical expenses.

47. There was no basis or evidence in the record to reject

Borron ' s opinion or reach any other conclusi on concerning a fair

allocation othe r than the amount of $11,657.66 proposed by

Petitioner s .

CONCLUSIONS OF LAW

48. The Agency for Health Care Administration is the state

agency responsible for administering Florida ' s Medicaid program.

§ 409.910(2), Fla. Stat.

49 . DOAH has jur isdiction of this matter , pursuant to

section 409.910(17)(b), and the proper standard of proof in this

proceeding for Petitioner s is a " preponderance of the evidence ."

JPHS , p. 11, ¶ 3(f) .

50 . " Medicaid is a cooperative federal - state welfare

program providing medical assistance to needy people. " Roberts

v. Albertson ' s Inc. , 119 So. 3d 457 (Fla. 4th DCA 2012).

Although state participation in this federal program is

voluntary, once a state elects to participate, it must comply

with federal Medicaid l aw. Id.

51 . Federal law requires that participating states seek

reimbursement for medical expenses incurred on behalf of Medicaid

recipients who later recover from legally liable third parties.

52 . Under the United States Supreme Cou rt ' s rea soning in

Arkansas Department of Health and Human Services v. Ahlborn ,

547 U.S. 268 (2006), the federal Med icaid anti - lien provision at

42 U.S.C. § 1396p(a)(1) would ban a lien on all proceeds from a

Medicaid recipient ' s tort settlement.

53 . Howeve r, the provisions in federal law , requiring

states to seek reimbursement of their Medicaid expenditures from

liable third parties , also create an exception to the anti - lien

law and authorize states to seek reimbursement from the medical

expense portion of the recipient ' s tort recovery.

54 . The Federal Medicaid Act limits Florida ' s recovery to

certain portions of settlement funds received by the Medicaid

recipient. This has been recently interpreted by the Florida

Supreme Court to be the amount i n a personal injury settlement

which is fairly allocable to past (not future) medical expenses.

Giraldo v. Ag. for Health Care Admin . , 248 So. 3d 53 (Fla. 2018).

55 . Petitioners settled the personal injury claim against

the third parties liable for the injuries associated with AHCA's

Medicaid claim. Accordingly, AHCA has a lien against the pas t

medical expense portion of P etitioner s' personal injury

settlement.

56 . The underlying question in this case, however, is ho w

much is AHC A entitled to rec over from Petitioners as payment for

past medical services provided to Rickey?

57 . Section 409.910(11) establishes a formu la to determine

the amount AHCA may recover for medical assistance benefits paid

from a judgment, award, or settlement from a t hird party.

Section 409.910(11)(f) states, in pertinent part:

Notwithstanding any provision in this section

to the contrary, in the event of an action in

tort against a third party in which the

recipient or his or her legal representative

is a party whi ch results in a judgment,

award, or settlement from a third party, the

amount recovered shall be distributed as

follows:

1. After attorney ' s fees and taxable costs

as defined by the Florida Rules of Civil

Procedure, one - half of the remaining recovery

shall be paid to the agency up to the total

amount of medical assistance provided by

Medicaid.

2. The remaining amount of t he recovery

shall be paid to the recipient.

3. For purposes of calculating the agency ' s

recovery of me dical assistance benefits

paid, the fee for services of an attorney

retained by the recipient or his or her legal

representative shall be calculated at

25 percent of the judgment, award, or

settlement.

4. Notwithstanding any provision of this

section to the contrary, the agency shall be

entitled to all medical coverage benefits up

to the total amount of medical assistance

provided by Medicaid. For purp oses of this

paragraph, " medical coverage " means any

benefits under health insurance, a health

maintenance organization, a preferred

provider arrangement, or a prepaid health

clinic, and the portion of benefits

designated for medical payments under

coverag e for workers ' compensation, personal

injury protection, and casualty.

58 . In short, section 409.9 10(11)(f) establishes that the

a gency ' s recovery for a Medicaid lien is limited to th e lesser

of: (1) its full lien ; or (2) one - half of the total awar d, after

deducting attorney ' s fees of 25 percent of the recovery and all

taxable costs, up to, but not to exceed, the total amount

actually paid by Medicaid on the recipient ' s behalf. See Ag. for

Health Care Admin. v. Riley , 119 So. 3d 514, 515 n.3 (Fla. 2d DCA

2013).

59 . Here, the parties agreed that application of this

formula to Petitioners' $285,000.00 s ettlement require s payment

to AHC A of the full $51,130.05 Medicaid lien. 6/ JPHS , p. 10,

¶ 10 .

60 . Another section, section 409.910(17)(b ) , provides a

method by which a Medicaid recipient may contest the amount

designated as recovered medical expenses , payable under

section 409.910(11)(f) . This is done at an administrative

hearing at DOAH. It is to the proof presented at the

administrativ e hearing, and to that proof alone, that a

determination concerning the proper allocation of the settlement

agreement for past medical expenses must be made.

61 . Mor e specifically, following the United States Supreme

Court decision in Wos v. E.M.A. , 133 S. Ct. 1391, 1396 (2013),

the Florida Legislature created an administrative process to

determine the portion of the judgment, award, or settlement in a

tort action that is properly allocable to medical expenses and,

thus, the portion of the recovery that may be used to reimburse

the Medicaid lien. Section 409.910(17)(b) states:

A recipient may contest the amount designated

as recovered medical expense damages payable

to the agency pursuant to the formula

specified in paragraph (11)(f) by filing a

p etition under chapter 120 within 21 days

after the date of payment of funds to the

agency or after the date of placing the full

amount of the third - party benefits in the

trust account for the benefit of the agency

pursuant to paragraph (a). The petition

s hall be filed with the Division of

Administrative Hearings. For purposes of

chapter 120, the payment of funds to the

agency or the placement of the full amount of

the third - party benefits in the trust account

for the benefit of the agency constitutes

fina l agency action and notice thereof.

Final order authority for the proceedings

specified in this subsection rests with the

Division of Administrative Hearings. This

procedure is the exclusive method for

challenging the amount of third - party

benefits payab le to the agency. In order to

successfully challenge the amount payable to

the agency, the recipient must prove, by

clear and convincing evidence, that a lesser

portion of the total recovery should be

allocated as reimbursement for past and

future medical expenses than the amount

calculated by the agency pursuant to the

formula set forth in paragraph (11)(f) or

that Medicaid provided a lesser amount of

medical assistance than that asserted by the

agency. [ 7/ ]

62 . In simple terms, if Petitioner s can d emonstrate , by a

preponderance of the evidence , that the portion of the settlement

agreement fairly allocated as payment for past medical expen se is

less than the amount the a gency seeks , then the amount

Petitioner s are obligated to pay would be reduced.

63 . How to arrive at this amount and fairly allocate the

past medical portion of an undifferentiated settlement agreement,

has not yet b een squarely addressed by the United States Supreme

Court:

A question the Court had no occasion to

resolve in Ahlbo rn is how to determine what

portion of a settlement represents payment

for medical care. The parties in that case

stipulated that about 6 percent of respondent

Ahlborn ' s tort recovery (approximately

$35,600 of a $550,000 settlement) represented

compensati on for medical care. Id. , at 274,

126 S. Ct. 1752. The Court nonetheless

anticipated the concern that some settlements

would not include an itemized allocation. It

also recognized the possibility that Medicaid

beneficiaries and tortfeasors might

collab orate to allocate an artificially low

portion of a settlement to medical expenses.

Wos , 133 S.Ct. at 1391, 568 U.S. 627, 634.

64 . In its recent opinion in Giraldo , the Florida Supreme

Court held that future medical expense damages recovered by a

Me dicaid recipient are not available as a source of reimbursement

for Medicaid payments. Rather, only past medical expenses may be

considered.

65 . Notably, and of particular significance to the proper

outcome of this case, the Florida Supreme Court st ated:

Because we hold that the federal Medicaid Act

prohibits AHCA from placing a lien on the

future medical expenses portion of a Medicaid

recipient ' s tort recovery, we remand with

instructions that the First District direct

the ALJ to reduce AHCA ' s lien amount to

$13,881.79. Although a factfinder may reject

" uncontradicted testimony, " there must be a

" reasonable [**8] basis in the evidence " for

the rejection. Wald v. Grainger, 64 So. 3d

1201, 1205 - 06 (Fla. 2011). Here, Villa

presented uncontradicted e vidence

establishing $13,881.79 as the settlement

portion properly allocated to his past

medical expenses, and there is no reasonable

basis in this record to reject Villa ' s

evidence. For this reason, no further fact

finding is required. (Emphasis added ).

Giraldo , 248 So. 3d at 53.

66 . In this case there was no evidence presented by AHC A to

contest or contradict the amoun t of $11,657.66 presented by

Petitioner s' expert as the fair and reasonable allocation due.

67 . Counsel for AHC A cross - examined Petitioner s' expert,

but elicited no information or evidence assailing his opinion

that the fair allocation was $11,657.66.

68 . In short, Petitioner s' expert testimony concerning a

fair allocation of the settlement a greement was unchalleng ed by

AHC A without any countervailing or contrary facts or evidence in

the record.

69 . As such, and based on this record, the undersigned is

constrained to conclude under the Florida Supreme Court ' s

observations in Giraldo , that $11,657.56 is the amo unt due t o

AHC A. See also Scott R. Brown v. Ag . f or Health Care Admin . ,

Case. No. 1 8 - 1844MTR ( Fla. DOAH Sept. 20, 2018). 8/

ORDER

Based on the foregoing Findings of Fact and Conclusions of

Law, it is ORDERED that the Agency for Health Care Administration

is entitled to payment of $11,657.56 from the amount recovered in

Petitioner s' personal injury matter.

DONE AND ORDERED this 1st day of February , 2019 , in

Tallahassee, Leon County, Florida.

S

ROBERT L. KILBRIDE

Administr ative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

t his 1st day of February , 2019.

ENDNOTE S

1/ As used herein, the term " unallocated " means that the

settlement agreement did not specify how much of the total

settlement amount was payment for Rickey ' s past medical expenses.

2/ Among other th ings, the c ourt ordered that AHC A ' s lien of

$51,130.05 be held in trust pending further action, but the order

did not addr ess or rule on the merits of AHC A ' s Medicaid lien

amount.

3/ As a result, AHCA did not " institute, intervene in, or join

in " the personal injur y action to enfo rce its rights as permitted

in section 409.910(11), or participate in the litigation of the

personal injury action against the Defendants.

4/ Additionall y, during cross - examination, AHC A ' s counsel did not

persuasively attack or quest ion h is expertise in this area.

5/ Borron had offered similar expert testim ony in an unrelated

court case.

6/ Nonetheless, and by way of this proceeding, Petitioner s

contest this amount and seek to pay a lower amount.

7/ The parties agreed t hat the proper standard for Petitioner s'

burden of proof under section 409.910(17)(b) is by a

preponderance of the evidence.

8/ Until the matter is squarely resolved by the Florida

Legislature or interpreted by Florida courts as such, this Final

Order is not intended t o endorse the proportionality test used by

Petitioner s as the proper or only method of determining a fair

allocation of past medical expenses in an unallocated personal

injury settlement. See generally Smith v. Ag. for Health Care

Admin. , 24 So. 3d 590, 5 91 (Fla. 5th DCA 2009). Rather, the

outcome in this case is driven solely by this record, and the

conclusion that the e xpert testimony presented by Petitioner s as

to the proper allocation of $11,657.66 was unchallenged,

unrefuted and n ot persuasively impe ached by AHC A. Giraldo , 248

So. 3d at 53 .

COPIES FURNISHED:

Kim Annette Kellum, Esquire

Agency for Health Care Administration

2727 Mahan Drive , Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Alexander R. Boler, Esquire

2073 Summit Lake Drive , Suite 300

Tallahassee, Florida 32317

(eServed)

Ashley E. Davis, Esquire

Office of the Attorney General

The Capitol, Plaza Level 01

Tallahassee, Florida 32399

(eServed)

Elizabeth A. Teegen, Esquire

Office of the Attorney General

The Capitol, Plaza Level 01

T allahassee, Florida 32399

(eServed)

Timothy L. Newhall, Esquire

Office of Attorney General

The Capitol, Plaza Level 01

Tallahassee, Florida 32399 - 1050

(eServed)

Floyd B. Faglie, Esquire

Staunton and Faglie, P.L.

189 East Walnut Street

Monticello, F lorida 32344

(eServed)

Thomas M. Hoeler, Esquire

Agency for Health Care Administration

2727 Mahan Drive , Mail Stop 1

Tallahassee, Florida 32308

(eServed)

Shena Grantham, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Talla hassee, Florida 32308

(eServed)

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Stefan Grow, General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Mary Mayhew, Secretary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Fin al Order is entitled

to judicial review pursuant to section 120.68, Florida Statutes.

Review proceedings are governed by the Florida Rules of Appellate

Procedure. Such proceedings are commenced by filing the original

notice of administrative appeal with the agency clerk of the

Division of Administrative Hearings within 30 days of rendition

of the order to be reviewed, and a copy of the notice,

accompanied by any filing fees prescribed by law, with the clerk

of the District Court of Appeal in the appellate district where

the agency maintains its headquarters or where a party resides or

as otherwise provided by law.