independent

Sunday 20 April 2014

Hospitals, consultants defrauding health insurers, says report

Hospitals and consultants are committing fraud against health insurance companies by charging for unnecessary treatments, a new report has found.

Health Minister Dr James Reilly has been advised to penalise people over the age of 30 who take out private health insurance for the first time.

As revealed in yesterday's Irish Independent, people will be rewarded for taking out private health insurance at a young age with cheaper premiums than those who only sign up later in life.

Dr Reilly published an independent report on proposals for achieving cost reductions in the private health insurance market. The report makes 32 recommendations to try and reduce costs.

It finds there is evidence of fraud, waste and abuse in the private health insurance industry.

"While the majority of healthcare providers are honest and well-intentioned, there is evidence of abuse in the system," the report says.

Among the anomalies found were:

* Claims being made for a semi-private beds when patients were on trolleys.

* Inappropriate invoicing.

* Inappropriate lengths of stay.

* Private fees for patients treated in a public hospital.

* Inappropriate invoicing for certain specified drugs, tests and prostheses.

* Consultants claiming benefit when they were not present or had not personally performed the procedures.

* Cross-speciality referral when they were not strictly clinically necessary.

The report says health insurers should publish data on money recovered from hospitals and consultants, along with co-ordinating their approach to tackling fraud, waste and abuse.

The industry should also fund a whistleblowing initiative for the reporting of abuse.

Dr Reilly said he will continue to focus on addressing costs in the private health insurance market, to keep insurance "as affordable as possible".

"The Government's clear objective is for the health insurance market to remain as competitive and affordable as possible, as we move towards a new system of universal health insurance," he said.

The move is part of a plan aimed at driving down the cost of health insurance for the consumer.

Discounts will also be offered to young people up to the age of 30 to get them to take out cover.

Under the system, which is known as lifetime community rating, a 60-year-old who took out insurance when they were 25 will pay the same premium as a 25-year-old.

But a 60-year-old who takes out insurance for the first time will be charged more.

Irish Independent

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