Notice To: Cynthia Coffey Whose Last Known Address

NOTICE TO: Cynthia Coffey Whose last known address is: 663 Belle Avenue, Hamilton, Ohio 45015 Please be notified that pursuant to Ohio Revised Code ("R.C.") 5164.58, the Department of Developmental Disabilities has determined that a Medicaid overpayment has been made to you while you were a Medicaid provider. As set forth in the Auditor's Report on Procedures Applied- Waiver Review Report, mailed to you on July 26, 2018, the Department has determined that, during the audit period of July 1, 2014 through June 30, 2017, you were issued an overpayment in the amount of $1,196.53. The Department has been unable to obtain voluntary repayment of the overpayment in accordance with Section 5164.58 of the Ohio Revised Code and 5160-71-02 of the Ohio Administrative Code. Additionally, in accordance with Ohio Revised Code 5164.60, interest is owed on the principal in the amount of $81.75 and daily interest in the amount of $0.17 that will continue to accrue until payment is received by the Department. You are entitled to a hearing on these charges if your written request is received by Lyndsay Nash, Associate General Counsel, Ohio Department of Developmental Disabilities, 30 East Broad Street, 12th floor, Columbus, Ohio 43215, within 30 days of this notice. If no request is received, the Department will request that the Ohio Department of Medicaid issue a final adjudication order finding you received an overpayment in the above amount, plus interest. 1-13, 1-20, 1-27/2019