Cigna wins $6M judgment against South Florida health care provider

Insurance provider Cigna (NYSE: CI) won a $6.02 million judgment against the owner of several Parkland health care providers over allegations that her companies filed false billings.

Broward County Circuit Court Judge Jack B. Tuter Jr. approved the judgment in favor of Cigna and against Victoria Sobrino-Sanchez on April 9. It was a stipulated final judgment, meaning both parties agreed to the findings of fact and judgment to resolve the litigation.

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That followed a $6.02 million judgment Tutor approved March 12 in favor of Cigna and against Palm Beach Autism Specialists, Connecting the Puzzle and ABA4Family. According to the ruling, Sobrino-Sanchez is the owner of all three Parkland-based companies.

Both of those rulings were based on counterclaims Cigna filed against the companies. Attorney George Wickhorst, who represented Sobrino-Sanchez before withdrawing from the case in 2023, couldn’t be reached for comment. She hasn’t been represented by an attorney since he withdrew, and she negotiated the stipulated settlement pro se (without an attorney).

Attorney Shari Gerson, who represents Cigna in the case, didn’t respond to a request for comment.

The lawsuit started in November 2020, when Palm Beach Autism Specialists and Connecting the Puzzle filed a complaint against Cigna for allegedly not paying claims for the therapeutic services they provided to children. Cigna responded by filing a counterclaim, which also named Sobrino-Sanchez. The court dismissed the claims against Cigna in July 2023.

According to the findings of fact in the stipulated judgment, Cigna learned in 2017 that Connecting the Puzzle submitted an unlawful insurance claim for psychotherapy services because it didn’t hold a license to perform such services. Sobrino-Sanchez performed ABA (applied behavioral analysis) therapy, not psychotherapy, according to the statement of facts. Cigna later opened an investigation into the billings of Connecting the Puzzle and found numerous unlawful claims submitted between May 2017 and August, 2020, including double billing, according to the statement of facts. It sent Connecting the Puzzle a demand letter for repayment of $6.02 million in claims.

Sobrino-Sanchez opened Palm Beach Autism Specialists in March 2020 and it billed Cigna $775,250 between that month and July 2020, according to the statement of facts. Cigna froze its claims in June 2020 and only paid $22,325 to that point, Cigna denied the majority of those claims because Palm Beach Autism Specialists failed to provide any supporting medical records, according to the statement of facts.

In December 2020, Sobrino-Sanchez opened ABA4Family and it billed Cigna $661,437 through May 2021, with Cigna paying $41,205 before flagging the account, according to the statement of facts. Three of the four patients were previously patients at Connecting the Puzzle or Palm Beach Autism Specialists. ABA4Family failed to provide proof that it collected copayments and deductibles, so Cigna denied the claims.

The stipulated judgment found Sobrino-Sanchez liable for fraudulent misrepresentation, negligent misrepresentation, and violating the Florida Deceptive and Unfair Trade Practices Act.

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