Medical cards: Family doctors are being paid to treat thousands of people with discretionary medical cards which appear now not to exist, the Comptroller and Auditor General has found.
John Purcell is an independent watchdog who oversees how public funds are spent. He reports directly to the Dáil.
In his annual report for 2005, published yesterday, Mr Purcell said the Department of Health believed the number of discretionary medical cards in existence across the State in recent years to be in the region of 75,000.
However, when he asked the different HSE regions for the number of people with such cards in their areas at the end of 2005 the total came to just over 45,000.
"The remuneration of doctors for medical cards assumes the existence of 75,000 discretionary cards. The figures provided by the HSE regions suggest the real figure may be far lower, perhaps as low as 45,600.
"The figure recorded by the Primary Care Reimbursement Service database is lower still at 36,000," his report states.
In response, the HSE said it was conducting a validation exercise which was "likely to reveal that the actual figure for the number of these cards is between 65,000 and 68,000". This is still fewer than the numbers of cards in respect of which doctors are being paid.
Mr Purcell said: "I was concerned that payments continued to be made on the basis of the 75,000 estimate, which now appears to be too high."
Some €10 million was paid to doctors in 2005 in respect of 75,000 medical cards.
Discretionary medical cards are in general given to individuals over the income guidelines for a medical card but who by reason of illness might face large medical bills.
The department said the whole issue of discretionary medical cards will now have to be addressed in the context of a major review of all aspects of the GMS contract.
Mr Purcell also found the discretionary medical card scheme was not being administered in a uniform way across the State.
The HSE said it accepted that geographical variations in the percentage of discretionary medical cards as a proportion of all cards "is an issue that warrants further examination" and this will be conducted as part of a process currently under way to validate the number of discretionary medical cards in existence.
An examination of the nursing home subvention scheme by the comptroller also found huge discrepancies in how subventions are given in different HSE regions. He surveyed 19 local health offices responsible for administering the scheme and found they paid different amounts of enhanced subvention.
They also applied different criteria for assessing means, with seven offices not taking a principal residence into account if the house was occupied by a relative. "This is not in line with the regulations," he said.
He noted: "Applying the different practices to a typical case showed that an individual or supporting family members could end up paying varying amounts to meet the cost of private nursing home fees depending on the area in which they were located.
For example, in the southern, northeast and three Dublin/ eastern HSE areas, no contribution would be required, whereas in the southeast, midwest and western areas, a substantial contribution could be required.
The HSE said a standardised approach would be implemented but only on a phased basis "because of the resource issues involved".