DR. VARINIA F. CABRERA
v.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
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The Third District Court of Appeal affirmed the Agency for Health Care Administration's termination of Dr. Cabrera from the Florida Medicaid Program for 20 years based on her failure to reimburse an overpayment or enter into a repayment agreement within 30 days, as mandated by statute.
A Medicaid provider must be terminated if she fails to reimburse an overpayment determined by final order or enter into a repayment agreement within 30 days, and the agency has discretionary authority regarding the terms of any repayment plan that courts cannot second-guess.
[1] An agency has discretionary authority to determine the terms of a repayment agreement for Medicaid overpayments, and a court shall not substitute its judgment for that of…
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Join FLexlaw to unlock all legal intelligenceDr. Cabrera and her company, Advanced Behavioral Association, LLC, were Medicaid providers. A final order determined the company owed $207,082.92 in o…
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LOGUE, J.
Dr. Varinia F. Cabrera appeals a Final Order of the State of Florida, Agency for Health Care Administration that terminated her with cause from the Florida Medicaid Program for a period of 20 years. Dr. Cabrera and her company, Advanced Behavioral Association, LLC, were Medicaid providers of behavioral analysis services. On January 3, 2020, the Agency rendered a Final Order against Advanced Behavioral providing that the Florida Medicaid Program had overpaid Advanced Behavioral $207,082.92 and requiring it to repay the overpayment plus statutory interest, administrative fines, and costs. This order was not appealed and was therefore final. Neither Advanced Behavioral nor Dr. Cabrera paid the overpayment, fines, and costs owed. The Agency offered Dr. Cabrera a repayment plan of $35,956.34 per month, but Dr. Cabrera testified she could not pay this and instead offered to pay $800.00 per month, which the Agency rejected. Section 409.913(30), Florida Statutes, provides: “The agency shall terminate a provider's participation in the Medicaid program if the provider fails to reimburse an overpayment or pay an agency-imposed fine that has been determined by final order, not subject to further appeal, within 30 days after the date of the final order, unless the provider and the agency have entered into a repayment agreement.” (Emphasis added). Florida Administrative Code Rule 59G-9.070(7)(s) also provides: “For non-payment 2 or partial payment where monies are owed to the Agency, and failure to enter into a repayment agreement, in accordance with sections 409.913(25)(c) and 409.913(30), F.S., the Agency shall impose the sanction of termination.” (Emphasis added). Each of these provisions mandates termination in the event of failure to repay an overpayment or to enter into a repayment agreement. It is undisputed that neither Dr. Cabrera nor ABA reimbursed AHCA for the overpayment or entered into a repayment plan. While Dr. Cabrera seeks to have us intervene to review the terms of the repayment plan offered by the Agency, we do not see anything in the statute that requires or authorizes us to intervene in that kind of agency decision. “[U]nder section 409.913, the agency has discretionary authority regarding mitigation.” Espinal v. State, Agency for Health Care Admin., 1 So. 3d 316, 317 (Fla. 3d DCA 2009). This Court “shall not substitute its judgment for that of the agency on an issue of discretion.” § 120.68(7), Fla. Stat. Dr. Cabrera has failed to demonstrate that AHCA’s decision was outside the range of discretion delegated to the agency by law, inconsistent with agency rule, inconsistent with officially stated agency policy or a prior agency practice, if deviation therefrom is not explained by the agency, or otherwise in violation of a constitutional or statutory provision. Id. Affirmed.
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