VHI 'billed for patients on trolleys'
THE VHI can end up wrongly paying out more than €1,000 to a public hospital even though a patient is on an emergency department trolley, the insurer's chief executive John O'Dwyer has admitted.
"We do random checks – but some slip through, I admit that," he said after a leading hospital consultant described the practice as a scandal.
Mr O'Dwyer was responding to a claim by Mater Hospital ophthalmologist Dr Michael O'Keefe, who said the insurance company was being billed in some cases for patients who were on trolleys.
Health insurers should only be billed if a patient is admitted to a ward, and this varies from €75 if they are in a public bed, up to €1,050 for a private room.
Mr O'Dwyer said the company had a special investigations unit, which specifically deals with inappropriate billing, and it recovered €6.9m in 2012.
Part of this total was due to patients in emergency departments being billed.
He said if a patient had not been admitted, and was on a trolley, the private charge of over €1,000 was inappropriate.
All the health insurance companies here are under pressure to reduce inappropriate costs because of the pressure they are putting on customers' premiums.
Dr O'Keefe said: "All these are being charged for zero service. It is a scandal. Even when finally admitted, they can be in a public ward and get nothing extra for their premiums."
Neither do private patients get any money back if they do not receive the full private service.
He told RTE's 'Today with Pat Kenny' show: "The public system is hugely reliant on private health insurance money. It is propping up the public system."
Moves are also afoot to make health insurers pay the full cost of a bed – even though a patient is in a public ward.
Currently, the insurer only has to pay €75 a night if the insured patient is in a public bed. He said this could put 8,000 jobs in the private system in jeopardy.
Mr O'Dwyer said the Vhi was obsessed with costs and had several checks in place, including phoning thousands of customers to verify what bed they occupied.
It had recently recouped around €2m after these checks. But the majority of their customers were put in private beds, he insisted.
In a statement, the insurer said if it received a particular number of queries about insured patients being on a trolley and subject to a charge, an audit was carried out to determine the extent of the practice.
A spokeswoman for the Mater public hospital said it complied "at all times with Vhi guidelines in respect of payments sought".
She said it does not bill for patients on trolleys in the emergency department or accommodation charges for those placed in a public ward.