HSE owed €200m as doctors fail to fill in claim forms
Published 30/09/2011 | 05:00
THE HSE is owed almost €200m in insurance claims for private healthcare -- a shortfall that is costing taxpayers an estimated €6m a year in interest.
The Dail Public Accounts Committee (PAC) heard yesterday that €85m of the total amount is owed because consultants are not completing insurance forms given to them by patients.
The claims are for private patients who use public facilities and need a consultant's signature before they can be submitted to the insurer.
The committee also heard the HSE was prepared for a maximum payout of €840m for medical negligence claims spread over a decade, but a lot of these are legacy payments. It anticipates paying €97m this year.
Labour's Derek Nolan pointed out that the €197m owed on insurance claims would have to be made up by borrowing until the money is paid in full.
The Galway West TD said these borrowed funds would cost the taxpayer around €6m a year in interest -- under the improved terms of the EU-IMF bailout -- and added consultants were not doing their job if they didn't fill out the forms on time.
The HSE said it was trying to chase the payments up, but claimed the current system was very complex.
HSE officials said they were in agreement with the Department of Health and the Comptroller and Auditor General about splitting, or decoupling, the collection of the hospital accommodation charge from the fee charged by the consultant for private patients.
This would allow the hospitals to bill insurers directly for accommodation charges and the HSE would get its money immediately for private patients staying in hospitals.
However, it is not yet clear if new legislation is needed to allow Health Minister James Reilly to implement the change. The HSE will also crack down on consultants with the largest backlog of claims in the next three months.
The biggest problem with consultants and unfilled insurance claims are in the Mid-Western Regional Hospital in Limerick, totalling €9.6m, Cork University and Beaumont Hospital with around €5m each, and Our Lady of Lourdes Hospital in Drogheda with €4.3m.
The HSE also says insurance companies are reluctant to pay out until they can see everything about a claim is in order and are querying €23m worth of claims.
HSE chief executive Cathal Magee said if all the money was paid back it would provide "a once-off cashflow benefit of up to €162m to the HSE".
Fianna Fail TD Sean Fleming said the HSE went after people who had bills of €100 for sprains and breaks by getting debt collectors to chase up their payments but was going easy on the consultants.