Delays by consultants block €85m due to HSE

A CONSULTANT at South Tipperary General Hospital has not yet signed claims that would release more than €1 million owed to the Health Service Executive by private insurers.

More than €85 million due from health insurance companies is outstanding because of the failure of hospital consultants to sign claims, the Oireachtas public accounts committee was told yesterday.

At Mercy hospital in Cork, the figure for one consultant was almost €700,000 and at Portiuncula Hospital, Ballinasloe, one consultant had not yet signed off on more than €550,000 in claims.

Health insurance companies will only reimburse public hospitals for the accommodation costs of a private patient when the primary treating consultant has signed the entire claim, including treatment charges.

The committee was told that at the end of August, almost €193 million was owed in private insurance claims, €85 million of which was awaiting the action of consultants.

Cathal Magee, chief executive of the HSE, said it had spoken to health insurers about the need to “decouple” the accommodation element of bills for private patients treated in public hospitals.

It had sought to collect the charge from insurers independently of the rest of the patient claim, but health insurers had refused. Decoupling was needed “as a matter of urgency”, he said.

If the HSE and voluntary hospitals were paid on normal commercial terms of 30 days, there would be a benefit of up to €162 million to the HSE, he said.

Paul Barron, assistant secretary at the Department of Health, said there were no powers available to allow the Minister for Health to make regulations enforcing decoupling. The department was taking legal advice on the issue, he said.

Committee chairman John McGuinness TD suggested the HSE and the department should “get their act together”.

The committee also heard that 12 hospital consultants who exceeded the percentage of private patients they were allowed to treat under their HSE contracts had been told they will have to pay a penalty of almost €100,000.

Mr Magee said 70 consultants were identified as having exceeded their private public patient ratio and two had lost their right to carry out private practice in public hospitals.

Some 12 were written to about the financial penalties they would have to pay and were asked to remit details of their income. So far none had responded.

The committee also heard the HSE could face medical negligence claims of up to €845 million.

Liam Woods, HSE national director of finance, said the book of potential claims was in excess of €845 million.

Some €97 million in claims would be paid out this year, up from €60 million last year, he said. Some 70 per cent of claims were in the area of obstetrics.

Seán Fleming TD raised concerns about “vicious” letters sent to individuals by debt collectors who had failed to pay accident and emergency charges. He accused the HSE of only going after “the little fella”.