Sunday, February 17, 2013
Metro columnist Dan Casey: Red tape ensnarls family in mess
- Precinct problems need to be fixed
- Commerce Park news is greeted with yawn, sigh
- Journalist recovering remarkably from crash
Read Dan's blog
It's doubtful you've ever heard of the Recipient Audit Unit of the Division of Program Integrity of the Virginia Department of Medical Assistance Services.
But with such a daunting 17-word title, you can bet it ranks up there with other government agencies in terms of its capacity to snarl a wife and mother of two in the finest grade of bureaucratic red tape.
Her name is Melissa Cadwell. She's been tangling with the RAU of the DPI of the VDMAS for months now. They've dunned her for $1,108.98 and are threatening to send the debt to collections.
Cadwell's saga is interesting, frustrating and littered with other acronyms, too: DSS, COBRA and FAMIS. Permit me to add another just one more: SNAFU.
Cadwell and her husband, Joel, live in the Pulaski County community of Fairlawn with their two children, Cody, now 17, and Alicia, 14. Joel's a disabled veteran who fought in both Iraq and Afghanistan.
Until March 2009, the family's health insurance came through her job at Goodyear. They lost that when Goodyear shut down its Radford operation and laid everyone off, she said.
The Cadwells couldn't afford expensive COBRA insurance (which requires a former employee to pay the entire cost) on her unemployment checks. So through the Pulaski County Department of Social Services, Melissa signed up Cody and Alicia for a health insurance program for low-income children called FAMIS, which essentially is Medicaid.
By April 2010 Melissa had landed another job with a large national bank. Her health insurance there started that June, so she called Pulaski County DSS and told them that the kids no longer needed Medicaid coverage.
"The caseworker at the time told me I needed to submit that in writing," Melissa told me. "And so I did, to the local Pulaski Department of Social Services. I did not send it certified. Now I wish I had."
Flash forward to March 2011. Melissa received a form from the state Department of Medical Assistance Services. It turned out to be a renewal form for FAMIS coverage her children had earlier received.
She didn't realize that at first, though. She assumed it was a simple request to update information. She dutifully filled it out, but before she was done she realized it might renew her children in a program she thought she had removed them from months earlier. So wrote on it: "Don't process — they've had insurance since June 2010."
Perhaps if she had not been truthful about that all the future hassles would have been avoided.
In September 2011, Melissa received something called a "notice of recipient fraud/nonfraud recovery."
"It said I had collected Medicaid benefits for children who were ineligible," Melissa said. Those dates were June 2010 through March 2011.
"You will receive a response from the Recipient Audit Unit regarding the amount of misspent funds and any further action required," it stated.
In September 2012, the RAU of the DPI of the VDMAS sent her the bill for $1,108.98 for FAMIS premiums for June 2010 through March 2011, even though the Cadwell kids were covered by Aetna during that period.
And this is when the bureaucratic tangling began.
Melissa is one of those people who saves documents and makes careful notes. So she was able to give me dates of the numerous unreturned phone calls she made, letters and appeals she sent, etc. I'd run it all down for you but there's not enough space in this entire section. Her file on this is more than 1 inch thick.
After the September 2012 letter, Melissa filed an appeal of the bill. She mailed it within the required 30 days, return-receipt requested.
More than a month later, VDMAS informed her she had missed the appeal deadline, so she must pay. She presented them with the return receipt she had requested, and suddenly the RAU of the DPI of the VDMAS found the appeal and reinstated it.
By this time, her original Pulaski County DSS caseworker had long ago left the agency, and there was nothing in Melissa's file noting she had dropped her children's FAMIS coverage in June 2010.
The appeal hearing was by telephone, and the hearing officer ruled against Melissa.
Melissa admits she made some mistakes along the way. A bureaucracy can be confusing for a wife of a disabled vet and a mom of two who's struggling to provide for her family.
One mistake: She didn't send in the FAMIS cancellation by registered mail in June 2010. Another: She did not dispute the first fraud/nonfraud notice. She says she didn't completely understand it.
Late Friday afternoon, Craig Markva, a VDMAS spokesman, said the agency could not comment on this case because Melissa can still file a second appeal. But he said it had been referred to VDMAS by the Pulaski County DSS. It was one of 1,539 investigations by the agency in 2012 that recovered nearly $3 million in misspent funds, he noted.
I did find another bureaucrat who lent a more sympathetic ear. His name is Jim Wallis. He's been director of the Pulaski County DSS since 1980. He's retiring in May.
Wallis called Melissa, listened to her story, and looked in her file. He could find no documentation that she tried to pull her kids out of FAMIS back in 2010. (She said she can't produce a copy of that June 2010 letter because the family computer she stored it on later crashed.)
But that doesn't mean she didn't send it, Wallis noted. "We make mistakes."
Wallis made some phone calls to Richmond on Friday. He said there's no doubt somebody dropped a ball here — either Melissa, or DSS or VDMAS. It's unclear precisely who, but "I believe her," Wallis added. Unfortunately, "under Medicaid, it doesn't make any difference whose fault it is. They will try to collect."
He added: "I know the rules, and [VDMAS] is following the rules. But sometimes, judgment needs to be applied to the rules. ... It irritates me this family is being treated this way. â? There's nothing in our record to indicate any type of fraud."
Wallis told me he would take up Melissa's cause, and try to get the $1,108.98 debt wiped clean.
"I think we need to give people the benefit of the doubt unless we know otherwise," Wallis told me. "Not everybody we deal with always tells the truth. On the other hand, we shouldn't assume everybody is like that."
Because he's retiring in a few months, Wallis said he doesn't really care whose toes he steps on trying to resolve this mess. There's no way anybody can retaliate against him.
And after more than 33 years of working in the bureaucracy, Wallis is an expert at slashing through red tape.
Too bad the rest of us can't always find such an advocate.