GPs won't be asked by HSE to give back overpayments

THE HEALTH Service Executive has said it will not be able to pursue GPs to recoup money paid out in error under the medical card scheme in respect of patients who had died because doctors are also owed money arising from delays in registering newborn infants.

The Dáil Public Accounts Committee was told in September that GPs operating the medical card scheme, who receive an annual capitation fee, had been overpaid by €1.48 million in respect of deceased patients.

TDs at the hearing asked senior HSE officials why they were not pursuing the doctors for the money paid to them in error with the same vigour as hospitals were going after patients for outstanding debts.

In a letter to the Public Accounts Committee on the issue, the HSE said it had addressed the matter of “death events” and the capitation payments and was working in concert with all interested parties to ensure that there were no overpayments or underpayments to GPs.

However, it said that the issue of GP overpayment in relation to client deaths could not be dealt with in isolation from the matter of underpayments to doctors.

It said that underpayments, which resulted from a delay in registering babies and the resultant capitation fee, as well as other issues of reported underpayments to GPs, had also to be considered.

“Recoupment could only be resolved in the context of an equally robust solution for payment of underpayments associated with births and reviews of eligibility,” the letter said.

“To this end the HSE has not written individually to general practitioners on this issue, but, to implement a long-lasting agreed solution to all of the issues involved, has met with the Irish Medical Organisation to enhance the systems that underpin maintenance of the list of medical card clients from which capitation is paid.”

The HSE said that a key enabler in moving these issues forward was the centralisation of the processing of medical cards, from more than 100 offices around the State to one central office.

“The results of the work done to date, with the co-operation of all of the stakeholders, ensures that there will be no overpayments or underpayments of capitation to GPs,” it said.

“The issue of GP overpayments in relation to client deaths could not be dealt with in isolation.

“The HSE has taken a number of strategic decisions, the resulting actions of which can properly address problems which have existed for longer than a decade and should be significantly better managed following the centralisation of medical card processing and the direct involvement of GP contractors.”

The HSE’s letter has been placed on the website of the Dáil Public Accounts Committee.