Sunday 22 April 2018

GPs claim treatment fees for dead card-holders

As Reilly told to save €113m, HSE bids to reclaim €1.5m from doctors

FAMILY doctors have claimed more than €1.5m of taxpayers' money for treating medical card-holders who are dead or don't exist,
FAMILY doctors have claimed more than €1.5m of taxpayers' money for treating medical card-holders who are dead or don't exist,
Maeve Sheehan

Maeve Sheehan

FAMILY doctors have claimed more than €1.5m of taxpayers' money for treating medical card-holders who are dead or don't exist..

As concerns grow that 100,000 people could lose their medical cards to meet €113m in savings announced in Budget 2014, some doctors have been creaming tens of thousands from the service both in overpayments from the State and in allowances.

It has emerged that some GPs continued to claim annual fees and payments for former patients who were either dead or had emigrated. Others charged the State overtime for seeing patients just minutes after 5pm. In one case highlighted last week by the Minister for Health, Dr James Reilly, a GP submitted a bill for €180,000 for "out of hours" allowances.

The €1.5m in overpayments was identified by the Health Service Executive (HSE) last year but not a cent has yet been repaid, despite its financial woes.

According to informed sources, the HSE will go to the High Court if necessary to recover the money. A deadline of October 31 was set for doctors who received the overpayments, following protracted talks with their professional body, the Irish Medical Organisation (IMO).

The overpayments to doctors is just a fraction of the €113m the Government wants to taken out of the medical card scheme. But both Dr Reilly and the Minister for Finance Michael Noonan latched on to the overpayments when justifying the €113m savings target last week. One source said the figure would cover the average cost of a medical card for 1,500 people.

The overpayments were identified by the Comptroller and Auditor General in his report this year, but Fianna Fail's Sean Fleming has claimed the HSE could be "squandering" as much as €5m a year on dormant cards.

The overpayments to GPs takes on a particular significance in light of the €113m the Government hopes to save from a "probity" review of medical cards, which is proving to be one of the most contentious measures in Budget 2014.

Analysis Pages 24-30 & 36

Opposition parties and concern groups have claimed that about 100,000 people would lose their medical cards this year. A further 35,000 over-70s are also set to lose their cards due to a change in income thresholds announced in last Tuesday's Budget.

Taoiseach Enda Kenny denied that the review of medical cards would turn into a "witch hunt", while Dr Reilly and the HSE have been forced to dismiss fears that seriously ill people who received discretionary medical cards could now lose them because they are over the strict income limits.

The medical card review has also signalled a rift between Dr Reilly and his senior cabinet colleagues, with the Health Minister attempting to disown the €113m savings target. In post-Budget briefings he said the figure was "given" to him by the Taoiseach and the Minister for Public Expenditure and Reform Brendan Howlin.

While sources close to Dr Reilly said the savings figure was foisted on him, others said it was imposed on Dr Reilly in frustration at his progress in identifying more savings in a department already cut to the bone.

Although the review of medical card eligibility was announced as a Budget measure, it has in fact been under way since earlier this year. The HSE embarked on a programme to weed out dormant medical cards after the system was centralised to one national office in 2011.

The Department of Public Expenditure and Reform latched on to the potential savings of between €65m and €210m highlighted in a HSE-commissioned PricewaterhouseCoopers (PwC) report on dormant medical cards.

The HSE warned that the PwC figures should be treated with "extreme caution". But officials in Public Expenditure relied on them to come up with a target of €113m, which was then "foisted" on Dr Reilly and the HSE.

The Minister for Health said last week he was "concerned" about achieving the savings while the HSE is getting the figures independently validated.

The biggest concerns are centering on discretionary medical cards, which are given to patients who fail the means test but are considered hardship or special cases. Almost 43 per cent of the population holds a medical card or a GP visit card, with each card estimated to cost the State €1,000 a year.

Sources said that politicians lobbying local health managers on behalf of constituents caused to a surge in discretionary medical cards being issued across the country, until the system was centralised in Finglas in 2011.

Politicians, parents and patients groups have reported an anecdotal rise in people losing their discretionary medical cards as part of a review of eligibility that has been ongoing since earlier this year.

The HSE has denied this. According to the latest figures obtained from the HSE on Friday, 23,000 discretionary medical cards were issued since the start of this year and around 10,000 discretionary medical cards were withdrawn. Of those, 4,500 cards were withdrawn because the holders exceeded the income guidelines – almost half of them by 200 per cent.

Another 4,500 were withdrawn because the holders didn't respond to queries. Around 800 had died.

The PwC report said there was an urgent need to "enforce" the removal of medical cards if people didn't respond to HSE queries about their eligibility: "Estimates of excess payments under the scheme could be in the range of approximately €65m to €210m per annum. Significant savings in annual expenditure could therefore arise as a result of the identification and removal of these ineligible card holders."

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