Medicaid overpaid a Miami psychologist’s firm $207,000. Unfair treatment ensued, she said
The state Board of Psychology revoked a West Miami-Dade psychologist’s license after another state body booted her from the Florida Medicaid program when her business didn’t repay $207,082 in Medicaid overpayments.
But Dr. Varinia Cabrera, who was licensed in Florida from Sept. 5, 2014 through the Aug. 11 revocation, said all her offers to repay the money on behalf of her business were rejected.
“As a professional, I offered to pay the Medicaid program in different options including selling the house where I live with my daughter who has disabilities,” Cabrera said via email. “The Medicaid program refused all the offers without giving any options but to pay the whole sum amount.”
Cabrera’s Florida Department of Health online license entry shows no discipline issues from Sept. 5, 2014, when she became licensed, through Aug. 11. She believes she was rushed to revocation unfairly by the Agency for Health Care Administration (AHCA), which administers Florida’s Medicaid program, and the Board of Psychology because she’s a Hispanic woman living in Miami, known for Medicare and Medicaid fraud.
“Overpayments are something that occurs everyday in the healthcare industry for different reasons, to hospitals and providers in general,” she wrote the Miami Herald in an email. “The Medicaid program wanted to ‘clean house’ in Miami and they assumed that everybody here is fraudulent.”
Where the Medicaid money went
The Medicaid payments in question went to Advanced Behavioral Association, a company Cabrera registered with the state in February 2016 while it was in Kendall, then moved to West Miami-Dade and Doral. The company provided behavior analysis services.
“Behavior analysis (BA) services are highly structured interventions, strategies, and approaches provided to decrease maladaptive behaviors and increase or reinforce appropriate behaviors,” AHCA said.
AHCA questioned whether five Advanced employees met minimum requirements to provide behavior analysis services that would be covered by Medicaid. If not, Advanced would have to return the overpayment to Medicaid.
Florida statute 409.913 says, in part: ““Overpayment” includes any amount that is not authorized to be paid by the Medicaid program whether paid as a result of inaccurate or improper cost reporting, improper claiming, unacceptable practices, fraud, abuse, or mistake.”
AHCA and an Administrative Law Judge determined that Advanced received #207,092 of overpayments. Advanced also owed 10% annual interest on that as well as a $2,500 fine.
That was in a final order that posted Jan. 3, 2020 and gave Advanced 30 days to pay all money owed or reach a payment plan agreement with AHCA. The order says the Administrative Law judge, two Medicaid offices and lawyers for AHCA and Medicaid were notified by email or electronic posting.
But, Cabrera, the order says, was notified by U.S. Mail. The 30 days ran out on Feb. 2, 2020. Cabrera claims the COVID-19 pandemic, which began its massive alteration of American life in March, prevented her from receiving mail informing her that Advanced was terminated from the program.
By May 2021, she knew.
Payback
Cabrera confirmed that AHCA offered her a repayment plan of $35,956.34 per month, and she responded that she could afford to pay $800 per month. AHCA rejected that idea, which would have taken Cabrera 21 years and six months just to pay off the principal.
Cabrera forwarded to the Herald a May 28, 2021, email she sent to AHCA senior attorney Bradley Butler on May 28, 2021, offering to accept a payment plan that AHCA proposed earlier in May: $25,000 down, $210,510 paid over 36 months. The proposed payment plan included “Medicaid Program Integrity is willing to not impose the sanction of termination (for cause term or without cause/contract term) if Ms. Cabrera enters into an acceptable repayment agreement.”
Cabrera forwarded to the Herald a responding email from Butler to her attorney that said, in part:
“I have been informed that the Agency is not interested in re-offering the below settlement or accepting either of the counter offers, received on May 26, 2021, or today, on May 28, 2021. I have been informed that the only way the Agency would consider delaying the Final Order terminating Ms. Cabrera for cause would be if the entire balance that is owed were paid to the Agency prior to the entry of the Final Order.”
Cabrera said, “They wanted to finish me. If they wanted the money, they would have accepted when I offered to pay one of the offers they gave me.”
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Appealing to a higher court
Cabrera appealed AHCA’s final order kicking her out of the Medicaid program for 20 years to Florida’s Third District Court of Appeal in October 2022.
After Advanced got hit with that by a Jan. 3, 2020, final order that also kicked Cabrera out of the Medicaid program for 20 years, Cabrera appealed the ruling to Florida’s Third District Court of Appeal.
The court said without any payment, Florida statute and administrative law ordered AHCA to kick Cabrera out of the Medicaid program.
That subjected Cabrera to the discipline of having her license revoked, which the state Board of Psychology did.
This story was updated after Dr. Cabrera reached out to the Miami Herald on Sept. 11 with new information.
This story was originally published August 16, 2023 at 3:43 PM.
