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The HSE is writing off millions of euro in insurance claims because they are not being processed on time, with €200million outstanding for treatment of private patients.
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they → publish → patients
Delays in processing claims – including a failure by consultants to sign off on paperwork – is resulting in millions of euro in debt being written off by cash-strapped hospitals each year.
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millions → process → hospitals
The Dáil’s Public Accounts Committee was told yesterday that at the end of last year the level of ‘private health insurer debt outstanding was €200million’, with PAC chairman John Brady TD calling the situation ‘scandalous’.
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TD → tell → situation
Of that amount, €68million worth of claims has yet to be submitted to insurers for payment, with €54million of that delayed because consultants have not yet signed off on the paperwork.
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consultants → have → paperwork
The Comptroller and Auditor General Séamus McCarthy ‘drew attention to continued delays in submitting patient charges claims to insurers’ at the PAC, which met for the first time in the new Dáil term yesterday.
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which → draw → term
He said €3.4million was written off last year as well as €4.1million in 2024, because claims were not submitted to the private insurers on time by the HSE.
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claims → say → HSE
In correspondence to the PAC, which has been obtained by the Irish Daily Mail, the HSE outlined that €78million has been written off in health insurer debt over the last six years, with consultants failing to sign off on reports listed as one of five primary causes.
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consultants → obtain → causes
‘Consultants not completing the claim form on a timely basis and insurer refuses to process the claim as it has exceeded their allowable time for claim submission,’ the correspondence states.
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correspondence → complete → submission
PAC chair and Sinn Féin TD John Brady told the Mail it ‘is absolutely scandalous’ that tens of millions of euro are being lost ‘due to poor administration’.
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millions → tell → administration
Consultants not completing the claim form on a timely basis,’ he said.
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he → complete → basis
He said a ‘radical overhaul’ of the system is needed.
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overhaul → say → system
‘This is an issue that PAC will be pursuing further, until the HSE and other voluntary hospitals begin to take their responsibilities with public money far more seriously,’ he added.
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he → pursue → money
The other primary reasons for writing off claims listed by the HSE include: the insurer disputing the length of stay and/or medical necessity of admission, the insurer deciding the patient’s policy does not cover the procedure or admission to the hospital, the insurer deciding that the episode of care relates to a pre-existing condition not covered by the policy or the patient exceeding the annual maximum total days in a hospital which is typically 180 days.
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which → write → hospital
The PAC was told that as the C&AG has no authority to audit the voluntary hospitals – despite them being funded from the HSE’s budget – and that the HSE does not know the level of debt write-off in these hospitals.
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HSE → tell → hospitals
The Mail has previously reported there is an ongoing row between the voluntary hospitals and the HSE over health board access to their accounts.
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Mail → report → accounts
A central national claims management system was set up in 2016 to monitor performance on private insurer claims billing and collection across all acute hospitals.
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system → set → hospitals
Mr Brady said it was a ‘glaring omission’ that the hospitals were outside of the scope of the C&AG.
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hospitals → say → C&AG
‘There’s a massive, massive glaring hole there in terms of accountability,’ he said.
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he → ’ → accountability
‘What the hell is that [national claims management system] doing, if we’re seeing this level of debt written off on an annual basis, that seems to me like a toothless tiger,’ he said.
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he → do → tiger
Mr Brady told the committee yesterday that it was ‘extremely concerning’ that a further €54million could be written off if consultants do not complete their paperwork.
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consultants → tell → paperwork
The HSE correspondence explains that when a patient arrives into a public hospital and wishes to avail of private treatment they complete the relevant paperwork and sign a form stating that the claim can be submitted to the insurer.
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claim → explain → insurer
According to the documents, the insurers require that the relevant paperwork is completed and signed by consultants and includes all charges relating to the patient’s stay.
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paperwork → accord → stay
The hospital’s accounts team then respond to queries from the insurers in relation to the claims, with consultants sometimes required to complete length of stay letters and provide medical reports regarding the patient’s stay.
‘Where insurers have not paid or part-paid claims, the hospitals make best effort to recover the hospital accommodation charge from the health insurer including appealing any rejected claims,’ the correspondence says.
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correspondence → respond → claims
Fianna Fáil TD for Roscommon/Galway, and former GP and president of the Irish Medical Organisation, Martin Daly told the PAC that there was a ‘systemic issue in the HSE’ and that he had a ‘real, real concern about the lack of digitalisation in our health service’ which meant tracking expenditure was challenging.
HSE chief Anne O’Connor appears before the PAC next week. The HSE told the PAC they are trying to improve their processes.
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they → tell → processes
A HSE spokeswoman told the Mail that ‘debt outstanding is showing a steady reduction’ with the figure going from €257million in 2020 to €200million currently.
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figure → tell → 200million
‘Of the €54million worth of claims referenced, approximately €42.7million is less than a year old, with €12million greater than a year old,’ she said, adding that the HSE has a window of 12 months to submit a claim with one health insurer under a deal in place since 2016.
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HSE → reference → 2016
For all other insurers the six years standard statute of limitations applies.
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statute → apply → limitations
The Irish Hospital Consultants Association and Insurance Ireland were contacted for comment.
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Association → contact → comment
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we → accept → article
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