19-003666MPI Agency For Health Care Administration vs. Zenith Psychological Services, Inc. Status: Closed Recommended Order on Tuesday, January 14, 2020.

Summary: Petitioner established its entitlement to reimbursement for Medicaid overpayments made to Respondent, payment of administrative fine, and recovery of its costs as provided by statute.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE

ADMINISTRATION ,

Petitioner ,

vs. Case No. 19 - 3666MPI

ZENITH PSYCHOLOGICAL SERVICES,

INC. ,

Respondent .

/

RECOMMENDED ORDER

A hearing was conducted in this case pursuant to sections

120.569 and 120.57(1), Florida Statutes (2019) 1/ , before Cathy M.

Sellers, an Administrative Law Judge ( " ALJ " ) of the Division of

Administrative Hearings ( " DOAH " ), on November 13, 2019, in

Tallahass ee, Florida.

APPEARANCES

For Petitioner: Susan Sapoznikoff, Esquire

Ryan McNeill, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Building 3

Tallahassee, Florida 32308 Ï 5403

For Respondent: No Appearance

STATEMENT OF THE ISSUES

The issues presented in this proceeding are : (1) w hether ,

Petitioner, Agency for Health Care Administration, is entitled to

repayment of an alleged Medicaid overpayment to Respondent ,

Zenith Psych ological Services, Inc., and, if so, the amount of

the overpayment to be repaid; (2) whether an administrative fine

should be imposed against Respondent, and, if so, the amount of

that fine; and (3) if warranted, the amount of any investigative,

legal, and expert witness costs to be assessed against the

Respondent.

PRELIMINARY STATEMENT

Petitioner performed an audit of Medicaid - related records

for the period of November 1, 2017, through October 31, 2018, to

determine whether Respondent had sufficient docume ntation to

establish that the behavior analysis and behavior assistant

services providers it employed possessed the qualifications

required by the October 2017 Florida Medicaid Behavior Analysis

Services Coverage Policy ("Behavior Analysis Policy") to be

e ligible to provide such services during the Audit P eriod.

On or about March 12, 2019, Petitioner issued the Final

Audit Report ( " FAR " ) , which constitutes the challenged agency

action in this proceeding. The FAR concluded that Petitioner

overpaid Responden t for services that, in whole or part, were not

authorized under the Medicaid program. Additionally, Petitioner

sought to impose a sanct ion for failure to comply with Medicaid

rules, and costs incurred as a result of the audit.

Respondent, through coun sel, timely requested an

administrative hearing, challenging the findings made and amounts

assessed in the FAR . 2/ The matter was referred to DOAH to conduct

a final hearing . The final hearing was initially scheduled for

September 9 through 11, 2019, but pursuant to Petitioner's

motion, was cont inued to November 12 through 14, 2019. On

October 22, 2019, the undersigned issued an Amended Notice of

Hearing setting the hearing for November 13, 2019.

Shortly after this matter was referred to DOAH, Responde nt

filed a Motion to Withdraw, requesting that its counsel of record

be granted permission to withdraw as counsel in this proceeding 3/ ;

t hat motion was granted. The motion identified another attorney

as the new contact on behalf of Respondent; however, th at attorney

advised Petitioner by electronic mail that he was not representing

Respondent in this proceeding , and he did not enter a notice of

appearance . N o other attorney or representative appear ed on

Respondent 's behalf . All pleadings, motions, notice s, and other

documents entered onto the docket of this proceeding were sent by

U.S. Mail to R espondent in care of its principal, Dr. Marie

Cheour, at Respondent's address of record; however, all of the

mailings were returned as undeliverable. DOAH also ma iled a copy

of the Amended Notice of Hearing to another address that had been

obtained for Respondent , and that mailing also was returned as

undeliverable. Additionally, DOAH made numerous attempts to

contact Cheour by electronic mail at various email add resses ; all

emails sent to her were refused as un deliverable. In any event ,

Respondent received notice of this proceeding, as evidenced by UPS

tracking information show ing that it received the FAR and by its

having initially retained counsel to represent it in this

proceeding .

Because Pet itioner has the burden in t his proceeding to

establish that it is entitled to reimbursement, by Respondent ,

for the alleged Medicaid over payments and to payment of an

administrative fine and costs, a final hearing w as conducted on

November 13, 2019 . Petitioner presented the testimony of

Robi Olmstead and Donald Burdick , and Petitioner's Exhibits 1

through 9 were admitted into evidence without objection.

Respondent did not appear, so did not present any testimony o r

tender any exhibits for admission into evidence.

The one Ï volume T ranscript was filed on December 16, 2019.

P roposed recommended orders were due on or before December 27,

2019. Petitioner 's timely filed P roposed Recommended Order has

been duly conside red in preparing this Recommended Order .

FINDINGS OF FACT

The Parties

1. Petitioner is the state agency authorized to make

payments for medical assistance and related services under

Title XIX of the Social Security Act. This program of medical

assist ance is designated the "Medicaid Program." Petitioner is

responsible for administering the Florida Medicaid Program in

accordance with state and federal law. See section 409.902, Fla.

Stat. As part of its statutory responsibilities, Petitioner is

charge d with operating a program " to oversee the activities of

Florida Medicaid recipients, and providers and their

r epresentatives, to ensure that fraudulent and abusive behavior

and neglect of recipients occur to the minimum extent possible,

and to recover ove rpayments and impose sanctions as appropriate. "

§ 409.913, Fla. Stat. 4/

2 . During the audit period of November 1, 2017, through

October 31, 2018 ("Audit Period") , 5/ Respondent was a Medicaid

provider enrolled to provide b ehavior a nalysis services , and h ad a

valid Non - Institutional Medicaid Provider Agreement with

Petitioner , as Medicaid Provider No. 019521800. Respondent

voluntarily contracted to be a Medicaid provider and was subject

to the applicable federal and state statutes, regulations, rules,

pol icy guidelines, and Medicaid handbooks adopted by rule that

were in effect during the A udit P eriod . As a condition of being

an authorized Medicaid provider, Respondent a greed to retain all

Medicaid and Medicaid - related records to satisfy all necessary

inq uiries by Petitioner .

The Audit

3. As part of its duties in overseeing the integrity of the

Medicaid program, Petitioner investigates and audits Medicaid

providers regarding services rendered to Medicaid recipients.

Pursuant to this authority, Petiti oner conducted an audit of

Respondent.

4. T he aud it was conducted to determine whether

Respondent had sufficient documentation to establish that the

persons it employed as behavior analysts and behavior assistants

possessed the qualifications required by s ection 3.2 of the

Behavior Analysis Policy , and, therefore, were eligible to provide

services during the A udit P eriod , and to verify that claims paid

to Respondent for behavior analysis services qualified for payment

under the Medicaid program.

5 . During the Audit Period, Respondent submitted claims

for services rendered by 139 employees for which Medicaid paid

Respondent a total of $3,732,173.05. Of these employees ,

Petitioner identified 46 who had rendered behavioral analysis

services during the Audit Period but were not qualified to do

so.

6 . Based on the audit, Petitioner determined that

Respondent had been overpaid for providing behavior analysis

services in the amount of $ 880,617.59.

7 . Petitioner prepared and sent a Preliminary Audit

Report ( " PAR " ) to Respondent. The PAR notified Respondent

that 46 of its employees had been determined not qualified to

provide behavior analysis services and set forth the amount of

overpayment associated with each of those employees .

Respondent was giv en the opportunity to reimburse Petitioner

for overpayment or submit additional records to substantiate

the qualifications of the employees Respondent had determined

unqualified to render behavior analysis services under the

Medicaid program .

8. Respon dent neither paid the amount calculated as due

in the PAR , nor sent any additional records to Petitioner to

substantiate the qualifications of its employees .

9 . Based on Respondent's failure to respond to the PAR,

Petitioner issued a FAR dated March 12 , 2019, MPI Case ID No.:

2017 - 0008498, finding that Respondent had been overpaid

$880,617.59 for certain behavior analysis services that were

performed by behavior assistant s who did not meet the

qualifications specified in section 3.2 of the Behavioral A nalysis

Policy. In addition, the FAR informed Respondent that Petitioner

sought to impose a sanction of $176,123.52 , pursuant to Florida

Administrative Code R ule 59G - 9.070(7)(e), and to recover costs of

$643.50 pursuant to section 409.913(23)(a). In sum, Petitioner

asserted in the FAR that Respondent owed Petitioner a total of

$1,057,384.61.

Evidence Adduced at the Final Hearing

10 . Section 1.0 of the Behavior Analysis Policy states:

"[b]ehavior analysis services are highly structured interventions,

str ategies, and approaches provided to decrease maladaptive

behaviors and increase or reinforce appropriate behaviors."

Persons who receive these services have mental health disorders or

developmental or intellectual disabilities. To ensure that

appropriate services are provided to these vulnerable individuals ,

behavior analysts and the behavior assistants who work with them

are required to have specified levels of education and training.

11 . Section 3.2 of the Behavior Analysis Policy sets forth

the qual ifications required for behavior assistant s to provide

behavior analysis services. Specifically, behavior assistants

must work under a lead analyst and must meet one of the following

qualification categories : ( 1) have a bachelor's degree from an

accredit ed university or college in a related human services

field; be employed by or under contract with a group, billing

provider, or agency that provides Behavior Analysis; and agree to

become a Registered Behavior Technician ("RBT") credentialed by

the Behavio r Analyst Certification Board by January 1, 2019 ; or

(2) be 18 years old or older with a high school diploma or

equivalent; have at least two years of experience providing direct

services to recipients with mental health disorders, developmental

or intelle ctual disabilities; and complete 20 hours of documented

in - service trainings in the treatment of mental health,

developmental or intellectual disabilities, recipient rights,

crisis management strategies , and confidentiality. To be

qualified to provide ser vices under the Medicaid program , behavior

assistants must either meet both requirements of the first

qualification category in section 3.2 , or all four requirements of

the second qualification category in section 3.2 .

1 2 . Respondent's records show tha t 46 behavior assistants on

its staff had not received a bachelor's degree in a related human

services field, and none of them had received RBT certification .

1 3 . Additionally, Respondent failed to provide records

showing that any of those same behavio r assistants met the

qualification s in the second category in section 3.2 .

1 4 . Respondent failed to submit any records substantiating

that two behavior assistants, Maulaire Seme and Patricia Charles,

met the requirements of either qualification categor y .

1 5 . Respondent's r ecords also failed to show that ten

behavior assistants had obtained a high school diploma or

equivalent . These behavior assistants are: Chantal Simeon,

Francia Joanis , Lisa Pederson , Maria Rouco , Marie Cherismat

Laguerre , Moniqu e Rowe , Pierre Merzier , Rodeline Joseph , Sabine

Exy, and Wi deline Thelemaque - Claire.

1 6 . Respondent 's records also failed to establish that 32 of

the 46 behavior assistants had received the required training in

section 3.2 . These behavior assistants are: Abigail Gamez , Carol

Charles , Chenelle Weaver , Claire Siffrant , Crescentia Stephen ,

D ayan D'Haiti , Denisse Paz , Diose Sylvain , Eva Platt , Ginette

Mindor , Jorge Pirella , Julian Luhtanen , Khandker Ahmed , Lens

Descius , Luis Velasquez , Lyse Pierre Paul , Madda Saintard Simon ,

Maidely Diaz Caro , Makenson Mathias , MaryMagdelen Cohen , Natacha

Beauge , Natacha Charles , Nord Voltaire , Rolando Gallegos , Shantal

Donovan , Sol M. Santana Ortiz , Stephanie Pierre Louis , Tarisha

Hartsfield , Vania Valdes , Whenzdjyny Sim on , Yarisley Echevarria ,

and Yvena Justabe .

1 7 . Respondent also failed to provide records for 15 of

these 32 behavior assistants show ing that they had at least two

years of experience providing direct services to recipients with

mental health disorders, developmental or intellectual

disabilities.

18 . In sum, Respondent failed to demonstrate that these 46

behavior assistants met the qualifications to render behavior

analysis services under the Medicaid program during the Audit

Period. Accordingly, the claims for their services must be

denied . 6/

19 . Based on the foregoing, it is determined that Respondent

was overpaid in the amount of $880,617.59 for the provision of

behavior analysis services that did not qualify for payment under

the Medicaid pr ogram .

CONCLUSIONS OF LAW

2 0 . D OAH has jurisdiction over the parties to, and subject

matter of, this proceeding, pursuant to sections 120.569 and

120.57(1).

Burden and Standard of Proof

21 . Petitioner bears the burden of proof in this proceeding ,

by a preponderance of the evidence, to demonstrate that Respondent

was overpaid by Medicaid for the claims billed. See South. Med.

Servs. v. Ag. for Health Care Admin ., 653 So. 2d 440, 441 (Fla. 3d

DCA 1995); Southpointe Pharm. v. Dep't of HRS , 596 So. 2d 106

(Fla. 1st DCA 1992).

22 . Additionally, in order for Petitioner to impose a fine,

it must establish the factual grounds for doing so by clear and

convincing evidence. § 120.57(1)(j), Fla. Stat.; s ee Dep't of

Child. & Fams. v. Davis Fam. Day Care Home , 1 60 So. 3d 854 (Fla.

2 015) ( disciplinary action by agency must be supported by clear and

convincing evidence).

Establishment of Overpayment

23 . Pursuant to section 409.913, Petitioner is authorized to

recover Medicaid program overpayments from Medicaid pro viders.

24 . A n " overpayment " is defined in section 409.913(1)(e) as

" 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 claiming, unacceptable practices, fr aud,

abuse, or mistake. "

25 . " A buse " is defined, in pertinent part, as " [p]rovider

practices that are inconsistent with generally accepted business

. . . practices and that result in an unnecessary cost to the

Medicaid program . " § 409.913(1)(a), Fla. S tat.

26 . The statutes, rules, and handbooks in effect during the

period for which the services being audited were provided apply in

a proceeding in which Petitioner seeks to recover an overpayment

of Medicaid claims. See Toma v. Ag. for Health Care Admi n ., Case

No. 95 - 2419 (Fla. DOAH July 26, 1996; Fla. AHCA Sept. 24, 1996).

27. The record keeping provisions of the 2008 and 2012

Florida Medicaid Provider General Handbooks require, in

pertinent part, that all providers maintain "all business

records as defined in 59G - 1.010(30) F.A.C., medical - related

records as defined in 59G - 1.010(154) F.A.C., and medical

records as defined in 59G - l.010(160)."

28 . The failure of a Medicaid provider to document that

its employees meet the applicable qualifications to provide

services in accordance with the applicable Medicaid handbooks

and the Provider Enrollment Agreement is inconsistent with

generally accepted business practices.

29 . The 2008 Florida Medicaid Provider General Handbook,

Incomplete Records section , states that "[p]roviders who are

not in compliance with the Medicaid documentation and record

retention policies described in this chapter may be subject to

administrative sanctions and recoupment of Medicaid payments.

Medicaid payments for services tha t lack required

documentation or appropriate signatures will be recouped."

30 . The 2012 Florida Medicaid Provider General Handbook,

Incomplete or Missing Records section, similarly states:

" [i] ncomplete records are records that lack documentation that

all requirements or conditions for service provision have been

met. Medicaid shall recover payment for services or goods

when the provider has incomplete records or does not provide

the records."

3 1 . Sections 409.913(7)(e) and (f) require providers t o

present claims for reimbursement in accordance with all Medicaid

rules, regulations, and handbooks, and to appropriately document

all good s and services provided.

3 2 . Section 409.913(21) states: " [w]hen making a

determination that an overpayment has occurred, the agency shall

prepare and issue an audit report to the provider showing the

calculation of the overpayment. "

3 3 . Section 409.913(22) states: " [t]he audit report,

supported by agency work papers, showing an overpayment to a

provider cons titutes evidence of the overpayment. " Consistent

with this provision, Petitioner can establish a prima facie case

of overpayment by proffering a properly supported audit report,

which must be received in evidence. See Colonial Cut - Rate Drugs ,

Inc. v. Ag . for Health Care Admin ., Case No. 03 - 1547MPI (DOAH Mar.

14, 2005; AHCA May 27, 2005); Full Health Care, Inc. v. Ag. for

Health Care Admin ., Case No. 00 - 4441 (DOAH June 25, 2001; AHCA

Oct. 4, 2001).

3 4 . In this case, Petitioner established a prima facie case

of overpayment by tendering its audit report, which was admitted

into evidence. Additionally, Petitioner presented credible,

unrefuted documentary and testimonial evidence establishing that

Respondent was overpaid for behavior analysis services perfo rmed

by unqualified behavior assistants, so that Petitioner must be

reimbursed for the claims paid for those services .

3 5 . Based on the foregoing, the undersigned concludes that

Petitioner proved, by a preponderance of the evidence, that

Respondent was overp aid for claims that failed to comply with the

laws, rules, and regulations governing Medicaid providers during

the Audit Period.

36. Accordingly , it is concluded that Petitioner is entitled

to reimbursement from Respondent for th o se claims in the amount of

$880,617.59.

Administrative Fine

37 . Petitioner is authorized to impose administrative

sanctions as appropriate. § 409.913(16), Fla. Stat.

38 . Rule 59G - 9.070, titled " Administrative Sanctions on

Providers, Entities, and Persons, " establishes , among other

thing s, the requirements for imposing administrative fines . Th e

rule provides , in pertinent part:

(7) Sanctions. In addition to the

recoupment of the overpayment, if any, the

Agency will impose sanctions as outlined in

this subsection. E xcept when the Secretary of

the Agency determines not to impose a

sanction, pursuant to section 409.913(16)(j),

F.S., sanctions shall be imposed as follows:

* * *

(e) For failure to comply with the provisions

of the Medicaid laws: For a first offense,

$1,000 fine, per claim found to be in

violation. For a second offense, $2,500 fine,

per claim found to be in violation. For a

third, or subsequent offense, $5,000 fine, per

claim found to be in violation.

39 . Here, Petitioner's witness testif ied that in calculating

the administrative fine to be imposed in this case , Petitioner

applied a sanction of $1,000 per claim that

was in violation [7/] and that would have come

out to $14,792 and no cents. However, the

statute allows us to cap 70 violatio ns at 20

percent of the overpayment. So that's what

was done in this instance. So the overpayment

was $880,617.59, capped at 20 percent, that

gave us the sanction of $176,123.52 for

(7)(e).

4 0 . In determining this fine amount , Petitioner apparently

relied on rule 59G Ï 9.070(4), which states , in pertinent part:

(4) Limits on sanctions.

(a) Where a sanction is applied for

violations of Medicaid laws (under paragraph

(7)(e) of this rule, . . . and the violations

are a "first offense" as set forth in th is

rule, if the cumulative amount of the fine to

be imposed as a result of the violations

giving rise to that overpayment exceeds 20%

of the amount of the overpayment, the fine

shall be adjusted to 20% of the amount of the

overpayment.

Fla. Admin. Code R. 59G Ï 9.070(4)(a)(emphasis added).

4 1 . However, Petitioner's witness testified that the amount

of the fine calculated under subsection (7)(e) of the rule was

$14,492 . This amount is substantially less than 20 percent of

the amount of the overpayment, wh ich equals $176,123.52 .

42. By its plain terms, rule 59G Ï 9.070 (4)(a) ÏÏ which is

titled " Limits on sanctions" ÏÏ only applies when the fine exceeds

20 percent of the amount of the overpayment . Because the amount

of the fine determined under rule 59G Ï 9.070(7 )(e) does not exceed

20 percent of the overpayment amount, rule 59G Ï 9.070(4)(a) does

not apply in this case to determin e the amount of the

administrative fine to be imposed.

4 3 . Petitioner did not present evidence establishing that,

pursuant to section 409.913(17), any circumstances exist that

warrant an enhanced penalty exceed ing the amount determined

pursuant to rule 59G Ï 9.070(7)(e).

4 4 . Accordingly, t he undersigned concludes that Petitioner

has presented clear and convincing evidence to support the

imposition of an administrative fine of $14,492 , pursuant to

rule 59G Ï 9.070(7)(e).

Entitlement to Recovery of Costs

4 5 . As the prevailing party in this proceeding, Petitioner

is entitled to recover "all investigative, legal, and expert

witness costs." § 409.913(23)(a), Fla. Stat. A party prevails

when it prevails on "significant issues in the litigation." See

e.g., Zhang v. D.B.R. Asset Mgmt. , 878 So. 2d 386 (Fla. 3rd DCA

2004) .

4 6 . A t the time Petitioner issued the FAR, it sought to

recover costs i n the amount of $643.50. Petitioner has since

incurred a dditional costs in preparing for and attending the

final hearing and preparing and filing its Proposed Recommended

Order, and it may incur additional costs related to this

proceeding .

Conclusion

47 . Based on the foregoing, it is concluded that Petitioner

is entitled to reimbursement from Respondent for Medicaid

overpayments totaling $880, 617.59 ; payment by Respondent of an

administrative fine in the amount of $14,492 ; and recover y from

Responden t of its costs , in a final amount to be determined.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that Petitioner, Agency for Health Care

Adminis tration :

A. Enter a final order requiring Respo ndent, Zenith

Psychological Services, Inc., to reimburse Petitioner the amount

of $880,617.59 for Medicaid overpayments and imposing an

administrative fine in the amount of $14,492.

B. Pursuant to section 409.913(23)(a), Petitioner, as the

prevailing par ty in this proceeding is entitled to recover all of

its investigative, legal, and expert witness costs.

DONE AND ENTERED this 14th day of January , 2020 , in

Tallahassee, Leon County, Florida.

S

CATHY M. SELLERS

Administ rative 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

this 14 th day of January , 2020 .

ENDNOTES

1/ All references to sections 120.569 and 120.57, Florida

Statutes are to the 2019 version.

2/ Petitioner mailed the FAR to Respondent's business address at

11770 Leeward Place, Boca Raton, 33428 Ï 5680, in c are of Dr. Marie

Cheour Gordon, Respondent's principal, who also went by the name

Dr. Marie Cheour. The FAR was successfully delivered to this

address.

3/ The Motion to Withdraw stated "Respondent, Zenith, has advised

that it no longer wishes to ret ain counsel to represent its

interests in this proceeding and has authorized Ms. Schrader and

Mr. Findley to file this Motion to Withdraw."

4/ The audit giving rise to this proceeding addressed services

rendered by Respondent between November 1, 2017, wh en the 2017

version of Florida Statutes was in effect, and October 31, 2018,

by which time the 2018 version of Florida Statutes was in effect.

The provisions of section 409.913 pertinent to this proceeding

were not amended during the 2018 legislative sess ion . Thus, for

expediency purposes, all references to section 409.913 are to the

2018 version.

5/ The audit period consists of the range of dates during which

services that were billed and paid by Medicaid were rendered. As

discussed in note 4 above, the services that are the subject of

this proceeding were rendered between November 1, 2017, and

October 31, 2018.

6/ Some of the behavior assistants who did not initially qualif y

to provide behavior analysis services subsequently became

qualified durin g the Audit Period. In calculating the total

overpayment amount of $880,617.59, Petitioner prorated the

overpayment amounts assigned to those behavior assistants , to

only deny the claims for services that were r endered during the

portion of the Audit Peri od when the behavior assistants were not

qualified . Those behavior assistants are : Monique Rowe, Sabine

Exy, Wideline Thelemaque Ï Claire, Abigail Gamez, Chenelle Weaver,

Claire Siffrant, Julian Luhtanen , Khandker Ahmed, Maidely Diaz

Caro, Makenson Mathias , and Yarisley Echevarria.

7/ The evidence shows that this proceeding entails Respondent's

first offense of failure to comply with Medicaid laws.

COPIES FURNISHED:

Susan Sapoznikoff, Esquire

Agency for Health Care Administration

2727 Mahan Drive , Ma il Stop 3

Tallahassee, Florida 32308

(eServed)

Ryan McNeill, Esquire

Agency for Health Care Administration

2727 Mahan Drive , Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Marie Cheour

11770 Leeward Place

Boca Raton, Florida 33428

Zenith Psychologi cal Services, Inc.

123 Northwest 13th Street , Suite 300A

Boca Raton, Florida 33432

Stefan Grow, General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Mary C. Mayhew, Secretary

Agency fo r Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308

(eServed)

Shena L. Grantham, Esquire

Agency for Health Care Administration

Building 3, Room 3407B

2727 Mahan Drive

Tallahassee, Florida 32308

(eServed)

Thomas M. Hoel er, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.