He Received Medicaid Coverage For Years. Now, the State Wants $32,000 Back. - THE CITY

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In the years he’s received Medicaid, Desiderio González hasn’t needed as much as a dental crown.

The state Department of Health approved him for coverage when the 62-year-old Bronx man first applied years ago. He grew to take the coverage almost for granted: He lived a healthy lifestyle and knew the benefits were there if he needed care.

But last year, the state claimed that he improperly received the benefits over the past five years and now owes nearly $32,000 in cash.

“I’m a working person,” González said in Spanish. “To be accused of stealing something — that’s outrageous. I’ve never stolen anything in my life.”

Situations like González’s, where people are suddenly saddled with exorbitant debts on grounds that they allegedly improperly received Medicaid benefits, aren’t uncommon in New York City.

In 2018 alone, the city’s Human Resources Administration, which doles out the state and federal funds, pursued 3,142 cases related to concealed or under-reported income, according to Politico, which reported on the issue a year ago. Attorneys who work with aid recipients contend the city often pursues such cases on inaccurate or other dubious grounds.

But the pandemic has complicated matters for González.

Income from the Williamsburg, Brooklyn, restaurant he owns and manages has declined dramatically in the last seven months, he said. And the tenants who live on the top two floors of his South Bronx home haven’t paid their rent during the pandemic, either.

Desy’s Clam Bar in Williamsburg, Brooklyn, Oct. 2, 2020.

Ben Fractenberg/THE CITY

His Medicaid repayment reprieve is set to expire at the end of the month. That’s when HRA is set to resume billings citywide on collections for Medicaid, SNAP and cash assistance settlements on Nov. 1, ending a pandemic-related moratorium the agency had put in place in late March.

The Legal Aid Society, which represents González and dozens of clients in similar positions, is asking HRA Commissioner Steven Banks in a letter to be submitted Tuesday to reconsider the decision to resume billings and instead extend the moratorium.

Agency officials should suspend “collection on existing agency payment or settlement agreements indefinitely while New Yorkers deal with the economic crisis caused by the COVID-19 pandemic,” Adriene Holder, attorney in charge of civil practice at the Legal Aid Society, urges in the letter.

“Many individuals and families are in no better financial position to meet these obligations now than they were in March,” she added. “In fact, many are much worse off. There is no reason to believe they will be in better financial circumstances come Nov. 1.”

HRA did not respond to requests for comment from THE CITY about the moratorium or González’s situation.

‘It’s Punishment’

When a Medicaid beneficiary is believed to have been improperly receiving coverage, the city is legally obligated to recoup the funds and pay them back to both the federal government and the state.

The claims are reviewed in a meeting with HRA agents, called an “investigation,” where the beneficiary must produce evidence — such as years of tax records, leases, and marriage, birth and death certificates — that retroactively prove their eligibility.

Legal advocates say the process puts an unfair burden on the recipients. “Calling this in the way it currently works as an ‘investigation’ is completely wrong,” said Erika Hanson, a Legal Aid attorney who is advising González. “It’s not an investigation — it’s punishment.”

González attended his October 2019 meeting alone before Legal Aid took on his case. He told THE CITY that he presented all his income and tax documents dating back at least a decade, including records he submitted when he first applied for Medicaid, to plead his innocence.

He said an agent had told him HRA had proof González had other sources of income that he had not declared, but refused to produce any evidence. If he did not sign the settlement and agree to pay back the $32,000 he allegedly owed, González said the agent told him, he would face arrest.

Dining chairs were piled up in Desy’s Clam Bar in Williamsburg, Brooklyn, while the restaurant just had outdoor dining, Oct. 2, 2020.

Ben Fractenberg/THE CITY

González connected with Hanson at Legal Aid approximately two months after he signed the settlement agreement.

He concedes he may have misinterpreted the agency: the settlement and the meeting were in English, which González does not speak and barely understands. A niece interpreted for him at that meeting, and he did not receive a Spanish-language copy of the settlement.

“If you fully comply with the terms and conditions of this Agreement, HRA/SDOH will not refer this specific claim for medical prosecution,” the settlement read. “By signing this agreement, you state that the information you gave during the investigation to HRA, as the representative of [the state Department of Health], and discussions about this case are true and complete, and you did not withhold material information.”

He said he reluctantly signed the agreement. According to the settlement, he was to begin paying $378.84 in monthly installments toward his debt in January 2020.

“I just signed it because it was what they told me to do,” said González. “But I left there feeling like I’d been robbed.”

Elusive Proof

Hanson reached out to HRA in February 2020 in a bid to void the settlement agreement González had signed, describing the agency as “usually open” to do so in such situations, where investigators are accused of misconduct or mistreatment, she said.

As in the original investigation, the agency allegedly declined to show proof that González was ineligible, and declined to void the settlement.

Hanson told THE CITY that based on all the information González has provided, he “would have been eligible” for benefits for the dates disputed.

But, she added, “when we brought that to HRA, they said, ‘Well actually we have all these leases for the floors of his house he rents out that contradicts the information that he filed in his taxes,’” she recalled.

“And I said, ‘Well, OK, can I see that? Because you’re hanging this whole claim on this information that he supposedly didn’t report on his taxes. And they said, ‘No, we can’t show you that.’”

González told THE CITY he doesn’t know what documents HRA is talking about, and said he disclosed the rentals on his taxes.

Even if González wasn’t eligible for his health insurance coverage, Hanson said, she wants his settlement tossed on grounds that he was not given due process.

“If even a fraction of what he described in that room happened,” like not being allowed to see the evidence against him, and allegedly being threatened with arrest if he did not agree to the settlement, “the settlement should be voided for that reason alone,” Hanson said.

Income Dried Up

According to Hanson, it’s likely González’s case will end up in court after the moratorium is lifted, as a result of missed payments. González’s income has all but evaporated due to the coronavirus pandemic, leaving him unable to pay the installments he owes so far this year.

And while the specific situation may be unusual, she noted, his economic difficulties are not. The same is true for families and beneficiaries likewise delinquent on their settlement payments because of the pandemic, the letter to Banks notes.

González was able to keep his restaurant open during the coronavirus shutdown, reducing hours of operation and scraping by on outdoor dining. He first opened his Grand Avenue eatery, Desy’s Clam Bar, a decade ago, with savings accumulated over 20 years as he worked his way up from dishwasher to line cook at a prior restaurant.

The tenants who live on the top two floors of his South Bronx home, González said, have not paid their rent during the pandemic.

He hopes the settlement is eventually tossed and the moratorium extended, but in the meantime, he’s unsure where he’ll get the money to make monthly payments. His credit cards are maxed out, he said, and he cannot bear to touch the funds he’s saved for his daughter’s college education.

His older sister’s death at age 80 from the coronavirus in April was another unexpected expense for the Colombian immigrant, who said he paid for his sibling’s burial.

“I just want what’s fair to me, for working people like myself,” González said in Spanish. “I’m an honest man, I’ve been in this country for 33 years, I pay all my debts.”

“This situation, for me, it’s just impossible.”

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He Received Medicaid Coverage For Years. Now, the State Wants $32,000 Back. - THE CITY
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