HomeMy WebLinkAbout2002 06 24 Regular O Medicare Overpayment
COMMISSION AGENDA
02~
June J..<>. 2002 //' 1fIlM,1I "frIo r
Meeting /~~ /'
Consent
Informational
Public Hearing
Regular X
ITEM 0
Mgr. /
Att. /
Dept.
REQUEST:
Authorize the City Manager to execute a Settlement Agreement with the State of Florida Attorney
General's Office regarding Medicaid overpayments. Further, instruct the City Attorney's Office to
seek reimbursement from MCPG for the costs associated with the investigation conducted by the
Florida Attorney General's Office and for any fees collected by MCPG on the overpayment.
PURPOSE:
The City of Winter Springs entered into an agreement with Medical Claims Processors Group, Inc.
(hereinafter "MCPG") on or about October I, 1998, for the purpose of providing billing and
collection services for emergency medical services treatment and transport. On or about April 26,
2001 the Winter Springs Fire Department (hereinafter "WSFD") was contacted by investigators for
the Office of the Attorney General, Medicaid Fraud Control Unit to discuss billing practices and
submissions. On or about April 27, 2001 MCPG notified the WSFD that due to a computer problem
at MCPG, MCPG submitted erroneously coded billing statements to the Florida Agency for Health
Care Administration, which resulted in Medicaid making overpayments to the City of Winter Springs.
MCPG indicated it was working with the Attorney General's Office to resolve the issue.
On March 11,2002 and March 14,2002 the WSFD received correspondence from the Attorney
General's Office indicating it had concluded its investigation and that the City had realized $1,346.91
in Medicaid overpayments due to erroneous billing statements. Further, the cost to Attorney
General's Office to investigate the matter was $2,741.00. At which time the WSFD sought the
Page 1 of 2
assistance and counsel of the City Attorney's Office.
To avoid further expenses associated with the collection of the Medicaid overpayments the Attorney
General's Office provided a proposed settlement agreement which has been reviewed by the City
Attorney's Office, which includes the cost of the overpayments and the investigation.
The City Attorney's Office is reviewing the agreement between the City and MCPG and will seek
reimbursement from MCPG under the agreement for the costs associated with the Attorney General's
investigation and for the percentage retained by MCPG on the overpaid bills.
APPLICABLE LAW AND PUBLIC POLICY:
Chapter 409, Florida Statutes
CONSIDERATIONS:
MCPG has admitted that due to a computer "glitch" it submitted erroneously coded billing sheets,
on behalf of the City, which resulted in overpayments by Medicaid.
If a settlement cannot be reached, the Attorney General will have no choice but to file suit for
collection, which will result in increased costs to the City.
The agreement between the City and MCPG provides that MCPG shall indemnify and hold the City
harmless for any claims, costs, or expenses, including attorney fees, incurred as a result of the
provision of the services provided by MCPG.
STAFF RECOMMENDATION:
Authorize the City Manager to execute the Settlement Agreement and to issue payment as directed
within ten (10) days. Further, instruct the City Attorney's Office to seek reimbursement from MCPG
for the costs associated with the investigation conducted by the Florida Attorney General's Office and
for any fees collected by MCPG on the overpayment.
ATTACHMENT:
Settlement Agreement
Service Agreement with MCPG
COMMISSION ACTION:
F:\Lawyer\jeffb\City of Winter Springs\Agenda Sheets\Medicaid Overpay Settlement 041502.wpd
Page 2 of 2
SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (the "Settlement Agreement") is entered into on
the last date signed below by both parties, between the City of Winter Springs
(hereinafter known as "CITY") which term whenever used herein shall mean the City of
Winter Springs, including all departments, divisions, officials, agents and attorneys and
the Office of the Attorney General (hereinafter the "OAG").
WIT N E SSE T H:
WHEREAS, the OAG commenced an investigation of billing submissions made on
the behalf of Winter Springs Fire Department, by Medical claims Processors Group, Inc.,
which resulted in over payments from the Agency for Health Care Administration
(hereinafter (AHCA); and
WHEREAS, the CITY and the OAG, desire to conclude the aforementioned
investigation and to settle and compromise all claims arising out of such investigation that
were asserted or maintained, could have been asserted or maintained, or which in the
future could be asserted or maintained by the OAG or the AHCA against the CITY for such
overpayment and;
NOW, THEREFORE, in consideration of the premises and the mutual promises,
agreements and covenants herein, including, but not limited to, the payment of the
Settlement sum as described in paragraph 4 below, and for other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
hereto stipulate and agree as follows:
1
I. As used herein the term "Investigation" shall mean the GAG's examination
of CITY's alleged improper receipt of Medicaid overpayments due to erroneous Medicaid
billings by the CITY's billing and collection service provider during the period January 1,
1998, through and including January 31, 2001.
2. The term "Parties" as used in this Settlement Agreement shall collectively
refer to the CITY and the GAG.
3. It is expressly understood and agreed between the Parties that this
Settlement Agreement, and the payment and release provided hereunder, are not and
shall not be construed to be an admission of liability or any acknowledgment of the validity
of any of the claims which were or which could have been asserted by the GAG against
the CITY, arising out of the Investigation, which liability or validity is hereby expressly
denied by the CITY.
4. The CITY agrees to pay to the State of Florida the sum of $4,087.91.
5. The CITY agrees to pay the amount provided in paragraph 4 above in one
lump-sum payment to the GAG, within 10 days of the date of this Agreement. If full
payment is not made as provided, this Settlement Agreement shall be of no further force
or effect and neither party shall have any right hereunder unless the payment date is
extended by the GAG in its sole discretion.
6. Upon full payment to the GAG of the amount provided in paragraph 4 above,
"
the GAG hereby agrees to release, acquit, and forever discharge the CITY from any and
all actions, causes of action, obligations, liabilities, claims, or demands for compensatory,
special, punitive, exemplary, or treble damages, claims or relief, or demand whatsoever
2
in law or in equity, civil or administrative, which were asserted or maintained, could have
been asserted or maintained, or which could in the future be asserted or maintained
against CITY in any action or proceeding, based upon, arising out of, related to, or
connected with, directly or indirectly, any of the matters in the Investigation.
7. The Parties have agreed that the payment and settlement made pursuant to
this Settlement Agreement constitute a complete resolution and settlement of all issues
and matters relating to or the subject of the Investigation. Upon CITY's fulfillment of its
obligations under' this Settlement Agreement and payment of the sums provided herein,
the Investigation, as defined in paragraph 1, shall be concluded.
8. The Settlement Agreement shall be binding upon and inure to the benefit of
the Parties.
9. This Settlement Agreement constitutes the entire agreement between the
. Parties with regard to the subject matter contained herein and all prior negotiations and
understandings between the Parties shall be deemed merged into this Settlement
Agreement.
10. No representations, warranties or inducements have been made by the GAG
concerning this Settlement Agreement other than those representations, warranties, and
covenants contained in this Settlement Agreement.
11. No waiver, modification or amendment of the terms of this Settlement
Agreement shall be valid or binding unless in writing, signed by the Party to be charged
and then only to the extent set forth in such written waiver, modification, or amendment.
12. Any failure by any Party to the Settlement Agreement to insist upon the strict
3
performance by any other Party of any of the provisions of this Settlement Agreement shall
not be deemed a waiver of any of the provisions of this Settlement Agreement, and such
Party, notwithstanding such failure, shall have the right thereafter to insist upon the
specific performance of any and all of the provisions of this Settlement Agreement.
13. This Settlement Agreement shall be governed by, and construed and
enforced in accordance with the laws of the State of Florida, without regard to its conflict
of law principles.
14. The Parties acknowledge that this Settlement Agreement is being entered
into to avoid the expense and length of further legal proceedings, taking into account the
uncertainty and risk inherent in any litigation.
. 15. This Settlement Agreement, any exhibit or document referenced herein, any
action taken to reach, effectuate or further this Settlement Agreement, and the terms set
forth herein, shall not be construed as, or used as, an admission by or against any of the
Parties of any fault, wrongdoing, or liability whatsoever, or as a waiver or limitation of any
defenses otherwise available to any of the Parties. Entering into or carrying out this
Settlement Agreement, or any negotiations or proceedings related thereto, shall not in any
event be construed as, or deemed to be evidence of, an admission or concession by any
of the Parties, or to be a waiver of any applicable defense. However, nothing in this
Settlement Agreement, including this paragraph, shall be construed to limit or to restrict
the CITY's right to utilize this Settlement Agreement, or payments made hereunder, to
assert and maintain the defenses of res judicata, collateral estoppel, payment, compromise
and settlement, accord and satisfaction, or any legal or equitable defenses in any pending
4
or future legal or administrative action or proceeding.
16. If any clause, provision, or section ofthis Settlement Agreement shall, for any
reason, be held illegal, invalid, or unenforceable, such illegality, invalidity, or
unenforceability shall not affect any other clause, provision, or section of this Settlement
Agreement, and this Settlement Agreement shall be construed and enforced as if such
illegal, invalid, or unenforceable clause, section, or other provision had not been contained
herein.
17. This Settlement Agreement, was executed after arms length negotiations
between the Parties and reflects the conclusion of the Parties that this Settlement
Agreement is in the best interest of all the Parties.
18. Each of the Parties participated jointly in the drafting of this Settlement
Agreement, and therefore the terms of this Settlement Agreement are not intended to be
construed against any of the Parties by virtue of draftsmanship.
CITY OF WINTER SPRINGS, FL
OFFICE OF THE ATTORNEY GENERAL
DEPARTME GAL AFFAIRS
, '
J ~p j.~j;> ----"
ROf) McLe~6r~,~Ci~ Manager
I f \ . .
, I
,
,
,
t.
RICHARD DORAN
Deputy Attorney General
for the State of Florida
'I ,
Date: June 27, 2002
s- D) - v ~
Date:
5
6
Received: 3/27/02 5:45PM;
.....-......, -..-. ',. ---
MAR-27-2002 17:47
CITY OF WINTER SPRINGS
407 327 4753
P.05
~
CITY OF WINTER SPRINGS FIRE DEPARTMENT
TERM CONTRACT NO. 98-01
Billing & Collection Services for Fire Department Emergency Medical Transport
TO: Medical Claims Processors Group, Inc.
P.O. Box 8063
Jupiter, FL 33468-8063
This is to inform you that the City of Winter Springs hereby enters into a Tenn Contract subject
to the following:
TERMS AND CONDITIONS
1. Acceptance:
This contract is our acceptance of your offer to operate as an Agency for the patient billing
and collection services of the Emergency M;edical Services of the City of Winter Springs,
Florida Fire Department. It is subject to all terms and conditions herein.
2. Tenn of Contract:
2.1 This is a tenn contract for the time period specified herein. It is entered into for the sole
purpose of purchasing services which are covered by this contract. The City is not obligated
to purchase any minimum amount of service, unless otherwise stipulated in the contract.
2.2 This contract shall be effective beginning October 1, 1998, and shall remain in effect
through September 30, 1999. '
2.3 Thirty (30) days prior to the expiration date listed in section 2.2, the City shall advise
the Agency of its intentions regarding the possible extension ofthe contract. The City shall
have the option to extend this contract fOT up to four (4) additional years past the expiration
date listed above, and any extension pursuant to section 2.3.
2.4 Both parties agree to a trial period of no more than ninety (90) days during which the
right to terminate the contract shall be suspended except as permitted under Paragraph 4.3.
2.5 The Agency will deposit collected funds into the City's designated bank account on the
same day as they are received. In addition, the Agency shall provide the City with validated
bank deposit slips on a weekly basis. It will be the responsibility of the City to provide the
agency with preprinted deposit slips.
Page 1 of7
Received: 3/27/02 5:45PM;
407 327 4/0;"
~1'''''''..I.JI..''.'H'''''''''''''' .---......
MAR~27-2002 17:47
CITY OF WINTER SPRINGS
407 327 4753
P.06
-,
3. Compensation
3.1 The City shall pay the Agency for the services described in section (1) herein 3,82% of
the amount collected. This rate shall be in effect for twelve (12) months from the date
hereof with an option for an extension for up to four (4) additional years at the same rate of
3.82% collection rate. In addition, the City shall compensate the Agency at a rate of5.5%
for any revenue generated by the Agency on all accounts which were previously assigned to
prior vendor, All payments by the City will be made in accordance with the "Florida Prompt
Payment ActH.
4. Code of Ethics and Debt Collection Practices
4,1 The Agency shall maintain and operate under a "Code of Ethics" to insure integrity and
confidentiality of the City and patients. A copy of this code is attached and incorporated
herein by reference.
4.2 The Agency covenants and agrees that it shall comply with, keep and follow the
guidelines, laws and regulations set forth in Chapter 599, Florida Statutes, and that it shall
not violate Florida Statute 559.72 prohibiting certain practices concerning consumer or
comm~cial collection, and all other laws) rules and regulations concerning commercial
collections. The Agency warrants that it is aware of and fully Imowledgeable of the laws
regarding collection practices including those set forth in Florida Statutes Chapter 559 and
warrants that it shall at all times remain knowledgeable of the laws set forth therein and any
amendments thereto, and any successor laws, rules and regulations pertaining thereto.
4.3 A violation by the Agency of either the Code of Ethics or any provision of Florida
Statutes Chapter 559, or any other law, rule or regulation concerning commercial collections
shall be grounds for the City's immediate termination of this Agreement upon the Agency's
receipt of notice from the City, without the thirty (30) day waiting period. In addition, the
Agency agrees to comply with the Federal Debt Collection Practices Act set forth in 15 U.S.
Code Section 1692 (a) - (0), and that any violation of that Act will also be grounds for
immediate termination of the contract.
4.4 Uncollectible account receivables will be written off after twelve (12) months from the
initial billing date. The City and the Agency will discuss this issue before any action is
taken to remove the set accounts. The City reserves right to make the final decision on the
accountS.
5. Indemnification
5.1 The City of Winter Springs, its officers and employees shall not be deemed to assume
any liability for the acts, omissions, and negligence of Agency, its officers and employees.
The Agency shall indemnify and hold the City and its officers and employees harmless from
any liability, claims, causes of action, costs or expenses either direct or indirect including
attorney's fees incurred as a result of, or arising under, this contract or the provisions of
services hereunder. .
Page 2 of7
Received: 3/27/02 5:45PM;
407 327 4753 _> BROWN.WAHD..~ALLMAI~&.II'\It:..L~~.t""J-'\; '-C;.r.\:;jl,;;!
MAR~27-2002 17:47
CITY OF WINTER SPRINGS
407 327 4753
P.07
S.2 The City shall be held harmless against an claims' of bodily injury, siclmess, disease,
death or personal injury or damage to property or loss of use resulting therefrom arising out
of performance of the contract, unless such claims are a direct result of the City's sole
negligence. The City shall also be held harmless against claims for financial loss with
respect to the provisions of or failure to provide professional or other services resulting in
professional, malpractice, or errors or omissions liability arising out of the contract, unless
such claims are a result ofthe City's sole negligence.
6, Insurance
6.1 The Agency shall be responsible for maintaining a general liability insurance policy
covering all actions taken by the Agency in connection with either its duties under this
contract or its relationship with the City. The general liability policy shall have a minimum
coverage of One Million Dollars ($1,000,000) per occurrence and One Million Dollars
($1,000,000) aggregate. The Agency shall provide to City a Certificate of Insurance on the
aforementioned policy immediately upon execution of this contract.
6.2 The insurance company and policy shall be in a form that is acceptable to the City. The
Agency shall notify the City at least thirty (30) days in advance of cancellation, non-renewal
or adverse, change to the policy. New certificates of insurance are to be provided to the City
at least thirty (30) days prior to coverage renewals.
6.3 Ifrequested by the City, complete copies of the insurance policies, forms and
endorsements will be furnished to the City within ten (10) days of written notice. The
receipt of certificates or other documentation of insurance or policies by the City, which
indicate less coverage than required, does not constitute a waiver by the City of Agency's
obligation to fulfill the insurance requirements.
7. Assignability
7.1 This contract is not assignable by either party.
8. Severability: Florida Law
8.1 If any part of this contract is adjudged invalid, all other parts herein shall remain valid
and enforceable. Florida law shall govern this contract.
9. Scope of Services
9.1 The Scope of Services attached herein is expressly made a part of this contract.
Page 3 of7
Received: 3/27/02 5:45PM;
407 327 4753 _> BROWN.WARD.SALZMAN&WEISS.PA; Page e
MAR-27-2002 17:48
CITY OF WINTER SPRINGS
407 327 4753
P.08
10. Miscellaneous Provisions
10,1 Notices. Any notices pursuant to this agreement shall be provided in writing to:
City Manager
1126 East State Road 434
Winter Springs, FL 32708
Copies To:
City Clerk
1126 East State Road 434
Winter Springs, FL 32708
Agency:
Medical Claims Processors Group, Inc.
Elaine Hines, President
P.O. Box 8063
Jupiter, FL 33468-8063
IN WITNESS WHEREOF, the parties hereto have signed this contract by their duly authorized
officers as of the day and year set forth above.
CITY OF WINTER SPRINGS, FLORIDA
MEDICAL CLAIMS PROCESSOR GROUP, INC.
BY:kJ1lU!tl W. 14'..t:---
Attc~';t 7~
BY:~~I)(!W~
Attest: rtOJ)VM ~
Page 4 of?
Received: 3/27/02 5:46PM;
407 327 4753 -> BROWN,WARD,SALZMAN&WEISS,PA; Page 9
MAR-27-2002 17:48
CITY OF WINTER SPRINGS
407 327 4753
P.09
CITY OF WINTER SPRINGS FIRE DEPARTMENT
BILLING AND COLLECTION SERVICES
SCOPE OF SERVICES
Winter Springs, Florida (City) desires to enter into a contract with an experienced and qualified
firm (Agency) to:
1. Provide billing and collection services for Emergency Medical Services treatment and
transport, as required on a case by case basis, with an emphasis on an accelerated turnaround
between services provided and payments received. The price bid or piggyback contract
herein shall include all expenses of billing and collection including, but not limited to,
stationary, forms, envelopes and postage.
2. Provide reasonably necessary training to appropriate City Fire Department personnel
regarding the gathering of necessary information and proper completion ofrun tickets.
3. Provide prompt submission of Medicare, Medicaid and insurance claims within ten (10)
business days after receiving the completed run ticket, which shall be the Agency's notice to
commence the billing/collection service. Secondary insurance provider claims shall be
submitted within ten (10) business days after the primary insurance provider has paid or
otherwise completed its processing of the claim. The Agency shall follow-up promptly on
rejected and inactive claims and establish payer remittance accounts and procedures.
4. Reconcile the number of transports collected with those transmitted to the Agency. The
Agency shall contact the Fire Department within twenty-four (24) hours of receipt to report
any discrepancies.
5. Agency shall provide a designed liaison for patient/payer concerns.
6. Provide survey questionnaires to patients at the City's request.
7. Provide all customer related inquiry services and prepare additional third party claims based
on this information exchange. Customer calls will be facilitated as local within metropolitan
Orlando or through an "800" exchange.
8. Implem~nt a collection system involving a minimum of three invoices and a follow-up
campaign of up to ten (10) telephone attempts to collect all private pay accounts with
outstanding balances, including required co-payments and deductibles assessed by Medicare,
Medicaid, HMO's or private insurance. Records of telephone calls and contacts shall be
maintained and any payment on an account shall reset this cycle. The Agency shall make an
attempt to locate the correct address for all returned mail to include up to three (3) attempts.
The City reserves the right to approve the invoice fonnat.
9, Attempt to collect all balances due for services rendered as well as attempt to assess patient's
ability to repay the debt and, if necessary, extend time payments, all subject to such policy
Page 5 of?
Received: 3/27/02 5:46PM;
407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 10
MAR-27-2002 17:48
CITY OF WINTER SPRINGS
407 327 4753
P.10
".
.' -
guidelines as the City may establish,
10. All requests for refunds will be forwarded to the City for any possible reconciliation. Refund
requests will be forwarded to the City on a weekly basis. It will be the responsibility of the
City to issue any refunds to clients.
11. The Agency shall provide to the City all unpaid invoices along with the complete processing
history once collection efforts described herein are exhausted. At the termination of the
agreement the Agency shall turn over all existing information in its possession concerning
then existing unpaid accounts to the City, Such information shall be transmitted by an
electronic medium (magnetic tape or diskette) reasonably acceptable to the City.
12. The Agency shall provide sufficient personnel to process all billing/run tickets in a timely,
efficient and effective manner and shall respond promptly to the City and patients on requests
for information or records,
13, Agency shall use any confidential records of care or treatment of patients solely for the
purpose of processing and collecting claims and shall not release any such information in any
legal action, business dispute or competitive bidding process other than disputes with the
City over billing services.
14. Any procedures described in this scope of services represents a minimum effort required by
the City of the Agency and shall not limit the Agency's use of its proprietary accounts
receivable and billing and collections systems, including modifications as required by major
provider groups, or its usual and customary practices. This agreement shall require a
minimwn standard of 60% collection success rate, The successful collection rate will be
calculated on a quarterly basis and reflect the percentage based upon what is billed versus
what is actually collected before any other action is taken on the account. The Agency will
be responsible for the amowrt of potential revenue that falls below the 60% minimwn,
Payment difference must be made before the end of each fiscal year or may be removed from
any fees paid by the City for said services.
15. Accowrts are subject to being reviewed by the City, and being available during normal
working hours to authorized City personnel. A listing of those personnel shall be provided
by the City,
16. The Agency, or its representative, must be licensed as a Health Claims Adjuster by the State
of Florida,
17. The City reserves the right to terminate this contract after a thirty (30) day written
notification to the Agency.
18. The Agency will be able to work previously billed accounts and be expected to collect on
accounts. The City agrees to compensate Agency 5.5% of the amount collected for these
accountS. A separate account shall be established to track these accounts.
Page 60f7
MAR-27-2002 17:48
CITY OF WINTER SPRINGS
\.
407 327 4753 _> BROWN,WARD,SALZMAN&WEISS.PA; Page 11
407 327 4753
P.ll
Received: 3/27/02 5:46PM;
'.
~. ...
) 9. The City agrees to work with the Agency to provide the required run information to best
facilitate the billing process.
20. The Agency agrees to notify the City when refund to a client is required. The City will be
responsible for mailing all refund payments. The City will advise the Agency of all accounts
created and provide copies of payments made to same.
21. The following reports shall be prepared and submitted by the Agency for review by the City.
All discrepancies shall be brought to the attention of the Agency within ten (10) working
days.
Reports
Patient AccountsIRun Number Cross Reference
End of Month Report Totals Confirmation
Transport Billed Run Number and Invoice Number
Accounts Receivable/Aged Trial Balance
Payments by Deposit/Collection Report
Run TicketITransport Tracking Report Corrections
Patient Account and Claim Follow up
Adjustment Report
Deposit Total Confirmation
Daily Cash Receipt Recap by Deposit
Collections by Payee Group
Page 7 of?
Frequency
Monthly
Monthly
Monthly
Monthly
WeeldylMonthly
Monthly'
Upon Request
Monthly
DailylMonthly
Daily/Monthly
Monthly
TnTOI D 1 1
. -:~
o'
WINTER SPRINGS
FIRE DEPARTMENT
102 NORTH MOSS ROAD
WINTER SPRINGS, FLORIDA 32708
TELEPHONE: (407) 327-2332
FAX (407) 327-4750
June 28, 2002
Ms. Penny J. Creech, Assistant Attorney General
Office of the Attorney General
Medicaid Fraud Control Unit
135 West Central Boulevard
Suite 1000, Century Plaza
Orlando, Florida 32801
Re: Medicaid Settlement Agreement
Dear Ms. Creech:
Please find enclosed the signed Settlement Agreement concerning the Medicaid
overpayments, and the bank check in the amount of$4,087.91 payable to the Office of
the Attorney General.
Thank you for your cooperation in this matter. If you have any additional questions you
may reach me at (407) 327-7575.
Sincerely,
Ti~at
Fire Chief
Enclosures 2
Cc: Ronald W. McLemore, City Manager
Anthony Garganese, City Attorney
Andrea Lorenza-Luaces, City Clerk
Finance
File
~
__L = ~ ::::::::~~:! ~
Cashier's Check
No. 1989910
..,~.{.,.."!_j
d.,. ""', ,h. . . .~. . ""':"':': '. ,. ,,'.!'::\Reh.1ilter{f1irBIJ.Bs~d~yr.'. .~. ::;' _., .. ..,.... ~
"". .,' '.',. /,;. .. ..,t~.40S7:~rt~1
".. UFOORTHOIJSAND EIGHTY SEVEN DOllARS AND 91 CENTS" .- $ .~
:.j
.~ ~
;&6'. '4-," -'" :~'i_
:' ;iC~:...,
". '- ';: ". ,": '". ;.: ,"".
. ... ...
. '. -' .
. . ...
d
". !
<1
":J
,>UOffICEROFTHE . ATTORNEY GENERAL U
,aau . .
:. .... . ~;"
, .. :", .~
Au!h
=:'.2~:"::-+~~~-fir-:~;~'....:..~:'/ )'
..... .... . -- '~'.- ......
(
)~
...........
II' . g B g g .011" I:...... 0 0 0 0 . g I:
00 . b .... .00 20 5 ....11.
...::-''::~~~~~-~_.'-.:::=;::~:;;:.:..:.;:.~~;:'.;.;;:~~WAT~ ON THE13ACJ(Q.1;,'!,;c".i'fHE ORIGINAL DOCu&fENT:HAs REFLECIlVE W A TERMARK ON THE BACK!1ti.
SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (the "Settlement Agreement") is entered into on
the last date signed below by both parties, between the City of Winter Springs
(hereinafter known as "CITY") which term whenever used herein shall mean the City of
Winter Springs, including all departments, divisions, officials, agents and attorneys and
the Office of the Attorney General (hereinafter the "OAG").
WIT N E SSE T H:
WHEREAS, the OAG commenced an investigation of billing submissions made on
the behalf of Winter Springs Fire Department, by Medical claims Processors Group, Inc.,
which resulted in over payments from the Agency for Health Care Administration
(hereinafter (AHCA); and
WHEREAS, the CITY and the OAG, desire to conclude the aforementioned
investigation and to settle and compromise all claims arising out of such investigation that
were asserted or maintained, could have been asserted or maintained, or which in the
future could be asserted or maintained by the GAG or the AHCA against the CITY for such
overpayment and;
NOW, THEREFORE, in consideration of the premises and the mutual promises,
agreements and covenants herein, including, but not limited to, the payment of the
Settlement sum as described in paragraph 4 below, and for other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
hereto stipulate and agree as follows:
1
I. As used herein the term "Investigation" shall mean the OAG's examination
of CITY's alleged improper receipt of Medicaid overpayments due to erroneous Medicaid
billings by the CITY's billing and collection service provider during the period January 1,
1998, through and including January 31, 2001.
2. The term "Parties" as used in this Settlement Agreement shall collectively
refer to the CITY and the OAG.
3. It is expressly understood and agreed between the Parties that this
Settlement Agreement, and the payment and release provided hereunder, are not and
shall not be construed to be an admission of liability or any acknowledgment of the validity
of any of the claims which were or which could have been asserted by the OAG against
the CITY, arising out of the Investigation, which liability or validity is hereby expressly
denied by the CITY.
4. The CITY agrees to pay to the State of Florida the sum of $4,087.91.
5. The CITY agrees to pay the amount provided in paragraph 4 above in one
lump-sum payment to the OAG, within 10 days of the date of this Agreement. If full
payment is not made as provided, this Settlement Agreement shall be of no further force
or effect and neither party shall have any right hereunder unless the payment date is
extended by the OAG in its sole discretion.
6. Upon full payment to the OAG of the amount provided in paragraph 4 above,
the OAG hereby agrees to release, acquit, and forever discharge the CITY from any and
all actions, causes of action, obligations, liabilities, claims, or demands for compensatory,
special, punitive, exemplary, or treble damages, claims or relief, or demand whatsoever
2
in law or in equity, civil or administrative, which were asserted or maintained, could have
been asserted or maintained, or which could in the future be asserted or maintained
against CITY in any action or proceeding, based upon, arising out of, related to, or
connected with, directly or indirectly, any of the matters in the Investigation.
7. The Parties have agreed that the payment and settlement made pursuant to
this Settlement Agreement constitute a complete resolution and settlement of all issues
and matters relating to or the subject of the Investigation. Upon CITY's fulfillment of its
obligations under this Settlement Agreement and payment of the sums provided herein,
the Investigation, as defined in paragraph 1, shall be concluded.
8. The Settlement Agreement shall be binding upon and inure to the benefit of
the Parties.
9. This Settlement Agreement constitutes the entire agreement between the
Parties with regard to the subject matter contained herein and all prior negotiations and
understandings between the Parties shall be deemed merged into this Settlement
Agreement.
10, No representations, warranties or inducements have been made by the GAG
concerning this Settlement Agreement other than those representations, warranties, and
covenants contained in this Settlement Agreement.
11. No waiver, modification or amendment of the terms of this Settlement
Agreement shall be valid or binding unless in writing, signed by the Party to be charged
and then only to the extent set forth in such written waiver, modification, or amendment.
12. Any failure by any Party to the Settlement Agreement to insist upon the strict
3
p~rformance by any other Party of any of the provisions of this Settlement Agreement shall
not be deemed a waiver of any of the provisions of this Settlement Agreement, and such
Party, notwithstanding such failure, shall have the right thereafter to insist upon the
specific performance of any and all of the provisions of this Settlement Agreement.
13. This Settlement Agreement shall be governed by, and construed and
enforced in accordance with the laws of the State of Florida, without regard to its conflict
of law principles.
14. The Parties acknowledge that this Settlement Agreement is being entered
into to avoid the expense and length of further legal proceedings, taking into account the
uncertainty and risk inherent in any litigation.
15. This Settlement Agreement, any exhibit or document referenced herein, any
action taken to reach, effectuate or further this Settlement Agreement, and the terms set
forth herein, shall not be construed as, or used as, an admission by or against any of the
Parties of any fault, wrongdoing, or liability whatsoever, or as a waiver or limitation of any
defenses otherwise available to any of the Parties. Entering into or carrying out this
Settlement Agreement, or any negotiations or proceedings related thereto, shall not in any
event be construed as, or deemed to be evidence of, an admission or concession by any
of the Parties, or to be a waiver of any applicable defense, However, nothing in this
Settlement Agreement, including this paragraph, shall be construed to limit or to restrict
the CITY's right to utilize this Settlement Agreement, or payments made hereunder, to
assert and maintain the defenses of res judicata, collateral estoppel, payment, compromise
and settlement, accord and satisfaction, or any legal or equitable defenses in any pending
4
or future legal or administrative action or proceeding.
16. If any clause, provision, or section of this Settlement Agreement shall, for any
reason, be held illegal, invalid, or unenforceable, such illegality, invalidity, or
unenforceability shall not affect any other clause, provision, or section of this Settlement
Agreement, and this Settlement Agreement shall be construed and enforced as if such
illegal, invalid, or unenforceable clause, section, or other provision had not been contained
herein.
17. This Settlement Agreement, was executed after arms length negotiations
between the Parties and reflects the conclusion of the Parties that this Settlement
Agreement is in the best interest of all the Parties.
18. Each of the Parties participated jointly in the drafting of this Settlement
Agreement, and therefore the terms of this Settlement Agreement are not intended to be
construed against any of the Parties by virtue of draftsmanship.
CITY OF WINTER SPRINGS, FL
OFFICE OF THE ATTORNEY GENERAL
DEPARTME GAL AFFAIRS
/~v.!/ (./ t'/{~~ /-~
Ron McLemore, City Manager
RICHARD DORAN
Deputy Attorney General
for the State of Florida
Date: June 27, 2002
:::;:-D)- v~
Date:
5 .
6
WINTER SPRINGS
FIRE DEPARTMENT
{P
~
102 NORTH MOSS ROAD
WINTER SPRINGS. FLORIDA 32708
TELEPHONE: (407) 327.2332
FAX (407) 327-4750
June 28, 2002 .
Ms. Penny J. Creech, Assistant Attorney General
Office of the Attorney General
Medicaid Fraud Control Unit
135 West Central Boulevard
Suite 1000, Century Plaza
Orlando, Florida 32801
Re: Medicaid Settlement Agreement
Dear Ms. Creech:
Please find enclosed the signed Settlement Agreement concerning the Medicaid
overpayments, and the bank check in the amount of$4,087.91 payable to the Office of
the Attorney General.
Thank you for your cooperation in this matter. If you have any additional questions you
may reach me at (407) 327-7575.
Sincerely,
~~I
Timothy 1. Lallathin
Fire Chief
Enclosures 2
Cc: Ronald W. McLemore, City Manager
Anthony Garganese, City Attorney
Andrea Lorenza-Luaces, City Clerk
Finance
File
~ankofAmerica ~
Cashier's Check
No. 1989910
}"1:.
I ;:::~..~':,;" .
Pay' .
T<i;
The
.gt,d,~r .,[
.. . .... c.
",' ~ : :., .'.
.Y :~. ",
'.,
. ..
..', ::::'>/.
..'
..'
:::::;:r ';,(;::~:<..~e~\t1?rJ~r~~:nt~d~~t<;
~~ -, .. -.
- .~. ".
~. .;.:
". .....
: :." ~.
.. ~.
.: ..; ~ ":.
:UfOQRTHOUSAND"E"iGHTY . SEVEN 'DOllARS '.'AND'91..' CENTS *.
$:.:
~ ..
.""~
)3
"i"f
..J
....,
"" t
:.J\l
,'.'",<1
:.:i-\...,i~
.... ....,.
. . ".;'::'~:
.......:............
....-;.......; "
......,.... .
.....:..
ank of Amenca N. A. '; "..' ::.' .,'~ ';.". .... .'.
~.~~!~o,i~;#s',.:~;'.~:. ,." :" ",.",^
. .
."' .. .. ,".
.;:;"."; ....
::, :......
.", u~.. .:'. .....:-;
.... .. ~- ~
":";..."f'
II' ~ gag g ~ 0 II' I: ~ * ~ 0 0 0 0 * g I: 00 * b ~ ~ 0 0 20 5 ~ II'
nn{ORlGINAI:~OO;HAs:REFJ:EC:rrYELWA:rn~ON~nfl{BACKI3'"2:~;~lrnKOR.IdIl\1AL~DOCUMENT HAS REFLECTIYEW A TERMAR.K ON TIlE BACK '!if.
SETTLEMENT AGREEMENT
THIS SETTLEMENT AGREEMENT (the "Settlement Agreement") is entered into on
the last date signed below by both parties, between the City of Winter Springs
(hereinafter known as "CITY") which term whenever used herein shall mean the City of
Winter Springs, including all departments, divisions, officials, agents and attorneys and
the Office of the Attorney General (hereinafter the "OAG").
WIT N E SSE T H:
WHEREAS, the OAG commenced an investigation of billing submissions made on
the behalf of Winter Springs Fire Department, by Medical claims Processors Group, Inc.,
which resulted in over payments from the Agency for Health Care Administration
(hereinafter (AHCA); and
WHEREAS, the CITY and the OAG, desire to conclude the aforementioned
investigation and to settle and compromise all claims arising out of such investigation that
were asserted or maintained, could have been asserted or maintained, or which in the
future could be asserted or maintained by the OAG or the AHCA against the CITY for such
overpayment and;
NOW, THEREFORE, in consideration of the premises and the mutual promises,
agreements and covenants herein, including, but not limited to, the payment of the
Settlement sum as described in paragraph 4 below, and for other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
hereto stipulate and agree as follows:
1
I. As used herein the term "Investigation" shall mean the OAG's examination
of CITY's alleged improper receipt of Medicaid overpayments due to erroneous Medicaid
billings by the CITY's billing and collection service provider during the period January 1,
1998, through and including January 31, 2001.
2. The term "Parties" as used in this Settlement Agreement shall collectively
refer to the CITY and the GAG.
3. It is expressly understood and agreed between the Parties that this
Settlement Agreement, and the payment and release provided hereunder, are not and
shall not be construed to be an admission of liability or any acknowledgment of the validity
of any of the claims which were or which could have been asserted by the GAG against
the CITY, arising out of the Investigation, which liability or validity is hereby expressly
denied by the CITY.
4. The CITY agrees to pay to the State of Florida the sum of $4,087.91.
5. The CITY agrees to pay the amount provided in paragraph 4 above in one
lump-sum payment to the GAG, within 10 days of the date of this Agreement. If full
payment is not made as provided, this Settlement Agreement shall be of no further force
or effect and neither party shall have any right hereunder unless the payment date is
extended by the GAG in its sole discretion.
6. Upon full payment to the GAG of the amount provided in paragraph 4 above,
the GAG hereby ag.rees to release, acquit, and forever discharge the CITY from any and
all actions, causes of action, obligations, liabilities, claims, or demands for compensatory,
special, punitive, exemplary, or tfeble damages, claims or relief, or demand whatsoever
2
in law or in equity, civil or administrative, which were asserted or maintained, could have
been asserted or maintained, or which could in the future be asserted or maintained
against CITY in any action or proceeding, based upon, arising out of, related to, or
connected with, directly or indirectly, any of the matters in the Investigation.
7.' The Parties have agreed that the payment and settlement made pursuant to
this Settlement Agreement constitute a complete resolution and settlement of all issues
and matters relating to or the subject of the Investigation. Upon CITY's fulfillment of its
obligations under this Settlement Agreement and payment of the sums provided herein,
the Investigation, as defined in paragraph 1, shall be concluded.
8. The Settlement Agreement shall be binding upon and inure to the benefit of
the Parties.
9. This Settlement Agreement constitutes the entire agreement between the
Parties with regard to the subject matter contained herein and all prior negotiations and
understandings between the Parties shall be deemed merged into this Settlement
Agreement.
10. No representations, warranties or inducements have been made by the GAG
concerning this Settlement Agreement other than those representations, warranties, and
covenants contained in this Settlement Agreement.
11. No waiver, modification or amendment of the terms of this Settlement
Agreement shall be valid or binding unless in writing, signed by the Party to be charged
and then only to the extent set forth in such written waiver, modification, or amendment.
12. Any failure by any Party to the Settlement Agreement to insist upon the strict
3
performance by any other Party of any of the provisions of this Settlement Agreement shall
not be deemed a waiver of any of the provisions of this Settlement Agreement, and such
Party, notwithstanding such failure, shall have the right thereafter to insist upon the
specific performance of any and all of the provisions of this Settlement Agreement.
13. This Settlement Agreement shall be governed by, and construed and
enforced in accordance with the laws of the State of Florida, without regard to its conflict
of law principles.
14. The Parties acknowledge that this Settlement Agreement is being entered
into to avoid the expense and length of further legal proceedings, taking into account the
uncertainty and risk inherent in any litigation.
15. This Settlement Agreement, any exhibit or document referenced herein, any
action taken to reach, effectuate or further this Settlement Agreement, and the terms set
forth herein, shall not be construed as, or used as, an admission by or against any of the
Parties of any fault, wrongdoing, or liability whatsoever, or as a waiver or limitation of any
defenses otherwise available to any of the Parties. Entering into or carrying out this
Settlement Agreement, or any negotiations or proceedings related thereto, shall not in any
event be construed as, or deemed to be evidence of, an admission or concession by any
of the Parties, or to be a waiver of any applicable defense. However, nothing in this
Settlement Agreement, including this paragraph, shall be construed to limit or to restrict
the CITY's right to utilize this Settlement Agreement, or payments made hereunder, to
assert and maintain the defenses of res judicata. collateral estoppel, payment, compromise
and settlement, accord and satisfaction, or any legal or equit~ble defenses in any pending
4
or future legal or administrative action or proceeding.
16. If any clause, provision, or section of this Settlement Agreement shall, for any
reason, be held illegal, invalid, or unenforceable, such illegality, invalidity, or
unenforceability shall not affect any other clause, provision, or section of this Settlement
Agreement, and this Settlement Agreement shall be construed and enforced as if such
illegal, invalid, or unenforceable clause, section, or other provision had not been contained
herein.
17. This Settlement Agreement, was executed after arms length negotiations
between the Parties and reflects the conclusion of the Parties that this Settlement
Agreement is in the best interest of all the Parties.
18. Each of the Parties participated jointly in the drafting of this Settlement
Agreement, and therefore the terms of this Settlement Agreement are not intended to be
construed against any of the Parties by virtue of draftsmanship.
CITY OF WINTER SPRINGS, FL
OFFICE OF THE ATTORNEY GENERAL
DEPARTME GAL AFFAIRS
;(;w.1i' /.J. '/'/./~~ ---.-:>
Ron McLemore, City Manager
RICHARD DORAN
Deputy Attorney General
for the State of Florida
Date: June 27, 2002
S-Di- u~
Date: .
5
6