VHI complained to gardaí over alleged fraud by provider

The VHI has made a complaint to the Garda over alleged fraud arising from a bill submitted by a healthcare provider last year .

The State-owned health insurer said yesterday that its special investigations unit had recovered about €20 million last year on foot of various investigations into potential fraud or incorrect or inappropriate invoicing by doctors and hospitals.

A spokeswoman for the company said that where cases of fraud were detected, they would be referred to gardaí for further investigation. She said in one case of alleged fraud last year gardaí had been called in and the matter was ongoing. VHI declined to comment on the amounts involved in that case or on whether the complaint related to either a doctor or a hospital.

Investigations unit

Details of the €20 million recovered by VHI's special investigations unit last year emerged in a presentation given by the insurer's new chairman-designate Liam Downey to the Oireachtas Joint Committee on Health and Children.

He said more widespread use of data analytics had been very effective and that more incidents of inappropriate billing had been identified. A spokeswoman for the VHI said that since its special unit was established in 2009, over €47 million had been recovered as a result of investigations of incorrect or inappropriate billing .

Inappropriate billing

The company said it had put in place a number of measures to deter inappropriate billing.

“For example, rather than just recover the money, we also now include penalties or fines, interest and investigation costs, thereby adding a financial cost to the offender which sends a strong message that there are consequences to their actions and activities.

"Where cases of fraud are detected, they will be escalated to An Garda Síochána for further investigation."

VHI said the most common anomalies identified were incorrect accommodation fees being invoiced by the hospital – for example where a patient was billed for a private room when the patient had actually occupied a semi-private room; bills submitted for inappropriate lengths of stay; charges being raised for cancelled procedures or private fees levied for patients treated in a public capacity; as well as inappropriate invoicing for certain specified drugs, tests and prostheses.

It said customers should contact VHI if they thought there was a mistake on their statement.