995 So.2d 984 (Fla.App. 1 Dist. 2008), 1D07-4608, Agency for Health Care Admin. v. Custom Mobility, Inc.

Docket Nº:1D07-4608.
Citation:995 So.2d 984, 33 Fla. L. Weekly D 2113
Opinion Judge:BROWNING, C.J.
Party Name:AGENCY FOR HEALTH CARE ADMINISTRATION, Appellant, v. CUSTOM MOBILITY, INC., Appellee.
Attorney:Justin M. Senior, Chief Appellate Counsel, Tallahassee, for Appellant., Cathy M. Sellers and Maureen McCarthy Daughton, of Broad and Cassel, Tallahassee and Beverly A. Pohl and Lester J. Perling, of Broad and Cassel, Ft. Lauderdale, for Appellee.
Case Date:September 04, 2008
Court:Florida Court of Appeals, First District

Page 984

995 So.2d 984 (Fla.App. 1 Dist. 2008)

33 Fla. L. Weekly D 2113

AGENCY FOR HEALTH CARE ADMINISTRATION, Appellant,

v.

CUSTOM MOBILITY, INC., Appellee.

No. 1D07-4608.

Florida Court of Appeal, First District.

September 4, 2008

Justin M. Senior, Chief Appellate Counsel, Tallahassee, for Appellant.

Cathy M. Sellers and Maureen McCarthy Daughton, of Broad and Cassel, Tallahassee and Beverly A. Pohl and

Page 985

Lester J. Perling, of Broad and Cassel, Ft. Lauderdale, for Appellee.

BROWNING, C.J.

The Agency for Health Care Administration (AHCA) appeals a final order of the Division of Administrative Hearings that held that a formula used by AHCA to calculate overpayments to Medicaid providers violated section 120.54(1)(a), Florida Statutes (2007). Because we find that the formula does not meet the statutory definition of a rule, we reverse the final order and remand the case for further proceedings consistent with this opinion.

AHCA is the state agency responsible for administering Florida's Medicaid program, for auditing Medicaid providers, and for recouping overpayments made to Medicaid providers. § § 409.902, 409.913, Fla. Stat. (2007). Appellee, Custom Mobility, is a Medicaid provider. AHCA conducted an audit of the Medicaid claims submitted for payment by Custom Mobility between January 1, 2001, and December 31, 2003. In a Final Audit Report (FAR) dated December 19, 2005, AHCA advised Custom Mobility that it had determined that Custom Mobility was overpaid in the amount of $245,317.83. The overpayment calculation was performed using the statistical formula for cluster sampling that is at issue here. Custom Mobility was notified in the FAR that it had the right to request a formal or informal hearing with respect to that overpayment determination; Custom Mobility requested a formal hearing. Custom Mobility set forth evidence intended to show that it is substantially affected by the formula, in that the formula was used as the basis for calculating the amount that AHCA is seeking to recover from Custom Mobility as alleged Medicaid overpayments.

When AHCA audits a Medicaid provider, it " must use accepted and valid auditing, accounting, analytical, statistical, or peer-review methods, or combinations thereof. Appropriate statistical methods may include, but are not limited to, sampling and extension to the population, parametric and nonparametric statistics, tests of hypotheses, and other generally accepted...

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