Poor financial controls led a cash-strapped hospital group to accumulate unpaid patient bills of nearly €21m and write off €898,266 in a year, an internal audit has revealed.
The Health Service Executive (HSE) audit of hospitals in Galway and Roscommon said the controls covering patient income were inadequate and in July 2012 claims for private patients requiring a sign-off by consultants were as high as €6m.
The claims related to 151 consultants and 22 of these were no longer employed by University Hospital Galway.
The financial weaknesses were among a series of deficiencies uncovered by the HSE's own audit team in a series of investigations across various areas of the service.
They included salary overpayments, allowing staff who had retired hold on to special credit cards, failing to record staff leave and giving doctors allowances they were not entitled to.
The audit of the hospitals in Galway and Roscommon found that a debt-collection agency was asked to recover €25,158 between June 2010 and August 2010 but by April 2013 only €3,340 had been returned.
"The debt-collection procedures are out of date," said the report.
An audit of the emergency department in Cork University Hospital found it had to write off €317,489 between January and October 2012.
Part of the money was deemed "irrecoverable" by a debt agency employed by the hospital but managers admitted to the auditors that it did not query why the agency took the decision.
"Therefore, suitable evidence is not held by the hospital in certain cases to justify the cancellation of an account," said the audit report obtained by the Irish Independent under the Freedom of Information Act.
The hospital was also found to be paying 10 junior doctors an overpayment of €10,180 in a "living out" allowance.
Particular concern was expressed about the lack of financial information found at the Sacred Heart Hospital, Older People's Services in Castlebar in Mayo.
An examination of the HSE-run nursing home was carried out after concerns about the "possibility of missing income" found a substantial loss of financial information because of control weaknesses.
The audit warned that "assurance cannot be given that all income due was identified, collected and recorded and the incomplete audit trail makes it difficult to identify a loss or to quantify a loss. There is increased risk of error and fraud".
It said that financial records were removed from the HSE premises with verbal authorisation and these cannot now be located despite the "reported but undocumented" return of the documents and searches.
An analysis of 2010 income indicated that the sums from elderly residents were receipted at €694,848 – but it did not match the €680,880 lodged in the HSE's bank account.
Other audits revealed:
* Health staff in the north-east were overpaid up to €31,470 in some cases.
* Some staff in the north-east who had retired still had special credit cards, which are used by staff to make purchases for their work. The former staff had not used them since they left the service. However, the HSE does not have any guidelines in place specifying the types of purchases it considers appropriate to charge to these cards.