Medical card check shows thousands ineligible

High level of excess payment found in system where cardholder’s circumstances improve

The report says there is a high level of excess payment in the medical card system where a cardholder’s financial circumstances change after being granted a card. Photograph: Alan Betson/The Irish Times

The report says there is a high level of excess payment in the medical card system where a cardholder’s financial circumstances change after being granted a card. Photograph: Alan Betson/The Irish Times

Tue, Oct 1, 2013, 06:43

Just 68 per cent of medical cardholders were deemed as eligible to hold medical cards last year after a review when they came up for renewal, according to the comptroller and auditor general’s report.

Large numbers of cardholders were found to have died, become ineligible or did not respond when contacted by HSE officials, according to a chapter in the report on medical cards. Cardholders who were allowed self-assess at time of renewal were more likely to find themselves eligible compared to those fully reviewed by the HSE.

The report says there is a high level of excess payment in the medical card system where a cardholder’s financial circumstances change after being granted a card. Although it doesn’t put a figure on this overpayment, it cites a 2011 report which estimated the potential exposure at between €65 million and €210 million.

Of 109,000 reviews carried out in 2012, 74,900 cardholders had their eligibility confirmed. A death notice was received in respect of 1,300 cardholders, 4,600 had their eligibility downgraded to a GP visit card and 9,000 were found to be ineligible because of a change in financial circumstances. Some 19,200 people did not respond.


Self-assessment
Self-assessment was applied in the review of 256,200 cases, of which 226,200 were found to be eligible.

It says the HSE has not begun legal proceedings against a single person in relation to false declarations or a failure to notify a change in circumstances. There is no legal basis for recovering “irregular payments” made by the HSE on behalf of a cardholder.

The report says a particular data protection issue was identified during checking, in that the Revenue Commissioner says they cannot provide the HSE with information about spouses. This issue reduces the usefulness of Revenue data in detecting ineligibility, it says.

Officials from the comptroller’s office looked at a sample of 50 people who had been approved for medical cards and found the vast majority satisfied the criteria for eligibility. However, in two cases, the cards were issued in error and in another two cases, the documentary evidence on file was inadequate.

Discretionary costs
In another three cases, discretionary costs such as medical costs were taken into consideration in assessing eligibility. GP reports were accepted as the main form of evidence but these did not always specify the number of doctor visits or the cost of medication.

Where a person is refused a medical card because income exceeds the set limits, he or she can still apply for a discretionary card on hardship grounds. Officials reviewed 25 of these applications and found that in a majority of cases, the cards were awarded on the basis of significant medical expenditure.

Cards are normally issued for three years (four where the person is over 66), but officials found that some people had been issued cards with an eligibility period of more than 20 years. Out of two million cardholders, just 22 people contacted the HSE last year to surrender cards because their circumstances had changed.

The report says the HSE should review the controls in place and provide staff with more specific guidelines for approving cards. It says a single week’s payslip should not be used to calculate a person’s annual salary.

By the end of last year, 43 per cent of the population held a medical card. More than one million fall for renewal in the year up to next April.