Medical-card monitoring too lax, HSE audit finds
Published 23/04/2015 | 02:30
Medical cards may have been given out by the HSE even though the patient was not eligible because of weaknesses in controls, a new report reveals.
The HSE's own audit, to be presented to the Dáil Public Accounts Committee today, also shows that a lack of monitoring left open the way for doctors and pharmacists to be overpaid.
- A sample of new medical cards issued could not always find necessary financial information in a person's file to prove eligibility.
- An examination of 25 cards in 2013 found that in one case, an applicant claimed they had a child aged 17 in full-time education - but this was not backed up with supporting evidence.
- The HSE's standard operating procedures for processing discretionary cards are unclear on when an application should be referred to a medical officer for review. This could give rise to ineligible cards being approved.
- Under the medical card scheme, a doctor receives an extra €17,000 a year rural practice allowance, where the population of the town in which they practise is less than 500 and no other medium sized town is within three miles. The audit found the population of the town is only verified the year the doctor joins the scheme.
- The HSE could not provide any files for a sample of 43 patients out of 50 who were getting expensive drugs under the High Tech Scheme because they had changed their pharmacist.
- There was no follow-up in a number of instances where pharmacists were alleged to have made claims for medications which the patient did not get.
These included a claim for 15 tubs of cream even though the patient said they only received one.
The audit also looked at grants made by the HSE to some voluntary hospitals and disability agencies and discovered a lack of oversight.
In one case, the agency received the Exchequer funding before its financial statements were audited.
In seven cases the service level agreement - setting out what they would provide in return for the funding - was only signed until the end of the grant year.
In the case of Our Lady's Hospital Crumlin there were no written policies and procedures on entertainment, credit cards and travel spending.
An audit found that in Cork, the eligibility of residents in receipt of funding under the Fair Deal scheme had not been tested since 2009.
The report is part of a probe by members of the committee arising out of the Comptroller and Auditor General 2013 Accounts and the HSE Performance Report 2014.
Senior officials, including HSE Director general Tony O' Brien, will be quizzed.