AETNA HEALTH, INC., F/K/A, AETNA U.S. HEALTHCARE, APPELLANT,
v.
21ST CENTURY ONCOLOGY, INC., APPELLEE
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
Aetna Health challenged a final order from the Agency for Health Care Administration (AHCA) adopting a dispute resolution recommendation in favor of 21st Century Oncology. After the parties settled their underlying dispute, they jointly moved to vacate the final order. The court held that AHCA has inherent authority to vacate final orders in settled disputes despite statutory language requiring adoption of recommendations.
AHCA has inherent or implied authority to vacate its final order in settled disputes. The statutory mandate to adopt dispute resolution recommendations applies only to unresolved claims disputes; once a dispute is resolved by settlement, the statutory scheme no longer constrains AHCA's discretion to vacate the prior order.
[1] An administrative agency possesses the inherent or implied power to rehear or reopen a cause to reconsider its action when the proceeding is essentially judicial in natur…
[2] An administrative agency, as a creature of statute, generally only possesses those powers expressly conferred by statute.
Previewing 2 of 5 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“By the plain language of the statute, the dispute resolution program only applies to unresolved claim disputes. Because the parties have resolved their claim disputes at issue, section 408.7057(4) does not prohibit AHCA from vacating its prior final order to facilitate the parties' settlement.”
Establishes the court's core holding that the statutory mandate to adopt recommendations applies only to unresolved disputes, creating an exception when disputes are settled.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceAHCA received a recommended order from Maximus, a dispute resolution organization, in December 2004 favoring 21st Century Oncology in a claims dispute…
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Statutory Construction cases and more on FLexlaw
POLSTON, J.
This matter arises from a claims dispute resolution process between the parties.
In December 2004, the Agency for Health Care Administration (“AHCA”) received a recommended order from Maximus, the organization under contract with AHCA for the dispute resolution process, in favor of appellee.
Pursuant to section 408.7057, Florida Statutes (2004), AHCA issued a final order, adopting Maximus’ recommendation. Appellant timely appealed the final order. During the course of this appeal, the parties amicably settled the dispute underlying the final order at issue.
However, as a condition of the settlement, the parties requested the underlying final order from AHCA to be vacated by filing a Joint Motion to Vacate the Final Order with this court.
On October 25, 2005, this court denied the motion, but sua sponte relinquished jurisdiction to AHCA for 30 days, to permit the parties to request AHCA, the proper forum, to vacate the order. After jurisdiction was relinquished, AHCA denied the joint motion, stating:
Unfortunately, while the parties’ arguments in support of their Motion are laudable, [AHCA] concludes section 408.7057, Florida Statutes (2005), the statutory scheme governing this matter, allows AHCA no discretion to vacate the Final Order. Specifically, Section 408.7057(4) states that within 30 days after receipt of the resolution organization’s recommendation, the “agency shall adopt the recommendation as a final order.” Because administrative agencies are creatures of statute and only have those powers conferred by statute, [AHCA] concludes that [it] cannot grant the relief requested by the Parties.
However, when jurisdiction over this matter returns to the First District Court of Appeal, [AHCA] respectfully suggests the Parties renew their request for the Court to vacate the Final Order. While AHCA is merely a tribunal in proceedings under section 408.7057, the Court appears to be the only tribunal with the legal authority to grant the relief sought by the Parties. Moreover, if AHCA’s interpretation of section 408.7057 is erroneous, then the Court has the authority under section 120.68(7), Florida Statutes (2005), to set aside the agency action at issue.
(Citation omitted).
AHCA’s interpretation of section 408.7057 is not one that we need give deference. See Health Options, Inc. v. Agency for Health Care Admin., 889 So. 2d 849, 851 & n. 2 (Fla. 1st DCA 2004).
Section 408.7057(2)(a), Florida Statutes (2005), directs AHCA to establish a dispute resolution program to “provide assistance to contracted and non-contracted providers and health plans for resolution of claim disputes that are not resolved by the provider and the health plan.” (Emphasis added).
By the plain language of the statute, the dispute resolution program only applies to unresolved claim disputes. Because the parties have resolved their claim disputes at issue, section 408.7057(4) does not prohibit AHCA from vacating its prior final order to facilitate the parties’ settlement. See Reich v. Dep’t of Health, 868 So. 2d 1275, 1276 (Fla. 1st DCA 2004) (reversing the Department of Health’s dismissal, for lack of jurisdiction, of appellant’s motion to vacate a final order entered by the Board of Medicine; stating that “[a]s a general rule, an agency has inherent or implied power to rehear or reopen a cause to reconsider the action taken therein, where the proceeding is in essence a judicial one”); Vey v. Bradford Union Guidance Clinic, Inc., 399 So. 2d 1137, 1138 (Fla. 1st DCA 1981) (recognizing an administrative agency’s power to control and modify orders, if timely done).
Therefore, because we hold that AHCA has the authority to vacate its previous final order, we again deny the parties’ renewed joint motion to vacate AHCA’s final order, dismiss this appeal because of the parties’ settlement, and remand to AHCA with instructions to vacate its final order to facilitate the settlement between the parties.
ERVIN and LEWIS, JJ., concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Blue Cross Blue Shield OF Fla., Inc. v. Outpatient Surgery Ctr. OF ST. Augustine, 66 So. 3d 952 (Fla. 1st DCA 2011)…, it is required to review the claim and issue a recommendation, unless the claim is withdrawn by the provider before the recommendation is issued (or the claim is settled by the parties, [*957] see Aetna Health, Inc. v. 21st Century Oncology, Inc., 919 So. 2d 619 (Fla. 1st DCA 2006)). The HMO is compelled to participate in that review process by providing documents in support of its position under the threat of the entry of a default. As a result, the HMO is in a far different position than the provider who…
-
M.B. v. Agency for Persons with Disabilities, 13 So. 3d 509 (Fla. 3d DCA 2009)…e law judge correctly acknowledged, APD had the burden of proving by a preponderance of the evidence that these three categories of services, though previously provided, should be reduced or eliminated. Wiggins v. Fla. Dep’t. of Children & Families, 919 So. 2d 619 (Fla. 1st DCA 2006); Fla. Admin. Code R. 65-2.060(1). Personal Care Attendant Services APD’s coverage and limitations rules are detailed in a “Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook” that is u…
-
AETNA Health, Inc. v. Orthopedic Assocs. OF Osceola, 920 So. 2d 768 (Fla. 1st DCA 2006)…on to vacate final order is denied. We remand this case to the Agency for Health Care Administration with instructions to vacate its final order to facilitate the settlement between the parties. See Aetna Health, Inc. v. 21st Century Oncology, Inc., 919 So. 2d 619 (Fla. 1st DCA 2006). This appeal is hereby dismissed. ERVIN, LEWIS and POLSTON, JJ., concur.…
Authorities Cited
- VEY v. Bradford Union Guidance Clinic, Inc., 399 So. 2d 1137 (Fla. 1st DCA 1981)
- Marvin Reich, M.D. v. Dep't OF Health, 868 So. 2d 1275 (Fla. 1st DCA 2004)
- Health Options, Inc. v. Agency FOR Health Care Admin. & Baycare Health Sys., Inc., 889 So. 2d 849 (Fla. 1st DCA 2004)