163 So. 3d 662
Fla. Dist. Ct. App.2015Background
- AHCA filed a petition for writ of mandamus challenging an ALJ order denying remand for additional factual findings after a formal hearing.
- Respondent physician was found overpaid $1,051,992.99 based on claims that documentation and peer review supported lower billing levels.
- AHCA argued Dr. O’Hern, the peer reviewer, qualified as a ‘peer’ under statute, potentially altering the factual basis needed for final agency action.
- The ALJ repeatedly declined remand, while AHCA issued a Partial Final Order remanding for factual findings, with AHCA asserting Dr. O’Hern’s peer status.
- AHCA then filed the mandamus petition asserting the ALJ’s failure to make necessary express factual findings on all contested Medicaid claims.
- The court treated the petition as a petition for review of non-final agency action under section 120.68(1) and granted relief, remanding for express findings on each claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ALJ departed from essential law by failing to make express factual findings on all contested claims. | AHCA. | ALJ. | Yes; remand required for factual findings on all claims. |
| Whether the petition should be treated as review of non-final agency action rather than mandamus. | AHCA. | ALJ. | Yes; proper under section 120.68(1). |
Key Cases Cited
- Agency for Health Care Admin. v. Mount Sinai Med. Ctr. of Greater Miami, 690 So.2d 689 (Fla. 1st DCA 1997) (adequate remedy under 120.68(1) for procedural issues when final decision may be stalemated)
- Borges v. Dep’t of Health, 143 So.3d 1185 (Fla. 3d DCA 2014) (final orders must include specific findings of fact)
- Gentry v. Dep’t of Prof'l & Occupational Regulations, 283 So.2d 386 (Fla. 1st DCA 1973) (requirement of express findings of fact in quasi-judicial action)
- Cohn v. Dep’t of Prof'l Regulation, 477 So.2d 1039 (Fla. 3d DCA 1985) (remand for further factual findings when officer failed to find facts)
- Charlotte County v. IMC Phosphates Co., 18 So.3d 1089 (Fla. 2d DCA 2009) (agency remand appropriate when law misapplied and facts remain)
- Harun v. Dep’t of Children & Families, 837 So.2d 537 (Fla. 4th DCA 2003) (remand for necessary findings of fact when administrative compliance is at issue)
- CNL Resort Hotel v. City of Doral, 991 So.2d 417 (Fla. 3d DCA 2008) (scope of review akin to certiorari for non-final agency action)
- Fugett v. Dep’t of Fin. Servs., 946 So.2d 80 (Fla. 1st DCA 2006) (certiorari-like review limits)
- Belair v. Drew, 770 So.2d 1164 (Fla. 2000) (due process considerations in agency action)