THE VHI has admitted it wrongly paid out €1m to a hospital for drugs that had been provided free as part of a breast cancer trial.
The insurer only found out it had been wrongly billed after a patient and senior hospital consultant Professor John Crown acted as whistleblowers. The invoices had been sent by St Vincent's Hospital in Dublin, where women were undergoing trials involving the drugs Taxoterre and Herceptin.
Prof Crown, who works as a senator and oncologist, used Seanad privilege to allege yesterday that his own hospital engaged in a "cover-up" over the €1m drugs overcharging.
“No, I will not be resigning. In fact, I’m going to do some work there right now,” he said.
In the Seanad, Prof Crown said he was making the statement about his own hospital with “a heavy heart”.
He said he had discovered back in 2002 that staff at the hospital had been fraudulently charging private health insurers in respect of cancer drugs that had been provided to that institution for free.
He said he had notified the relevant authorities and the Irish Medicines Board about it. But he said there had been a “cover up” by the management and board of St Vincent’s hospital.
“Substantial intimidation was brought to bear at the time that the whistle was blown on this 10 years ago,” he said.
Prof Crown said further documents had recently came into his possession which referred to money being fraudulently taken from the VHI and from other private health insurers.
The leader of the Seanad, Fine Gael senator Maurice Cummins, agreed to bring the matter to the attention of Health Minister James Reilly. Prof Crown is going to send the documentation he has to Dr Reilly.
Prof Crown’s right to privilege in the Seanad means he cannot be sued by the hospital group as a result. St Vincent’s Healthcare Group, which is owned by the Religious Sisters of Charity, is split into two parts on its campus.
St Vincent’s Healthcare Group board chairman, Professor Noel Whelan, has written to Prof Crown to ask him to pass on all information “as a matter of extreme urgency”.
In a statement, St Vincent’s said that an independent investigation of the drugs over-charging by PricewaterhouseCoopers had not indicated “any evidence of collusion or fraud by staff or within the hospital”.
The Irish Medicines Board (IMB) confirmed that Prof Crown contacted it in September 2002.
It said that he had informed the board that charges were being applied by St Vincent’s Private Hospital for medicines supplied free of charge to the hospital for patients participating in clinical trials.
But the IMB said that the financial arrangement between a hospital and a private health insurer did not fall under its remit.
Prof Crown is among the highest-earning specialists in the country, with a public salary of around €180,000 and has a lucrative private practice.
But he donates his €65,600 Seanad salary to cancer research.
A VHI spokeswoman said: “As part of this commitment, we have a special claims investigations unit (SIU), which is dedicated to ensuring that incidences of error or overcharging by healthcare providers are fully investigated and rectified.
“In addition, we have a number of robust measures in place to ensure benefit paid on behalf of our customers is appropriate and warranted including pre-verification of claims, data analytics, on-going audits, clinical reviews and utilisation management,” she added.
Michael Brennan and Eilish O'Regan