The Health Service Executive made €3.89 million in duplicate payments to general practitioners (GPs) over a three-year period, according to an internal audit that raised concern about the risk of “potential fraud”.
The audit, completed in June and published on Thursday, examined GP fees and allowances under the HSE’s primary care reimbursement system (PCRS).
GP funding used to be largely handled through a system that provided a set monthly payment for each patient, depending on age and gender.
In recent years, there has been an increase in activity-based payments, in which GPs get paid for carrying out specific services including termination of pregnancy, chronic disease management and support for Ukrainian refugees.
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According to the audit, the PCRS has “successfully managed” the significant increase in volume and complexity of GP payments in recent years, but the shift to activity-based funding has “heightened the inherent risk of error and fraud”.
There is a “significant” challenge in verifying and validating these activity-based claims, the audit found.
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In late 2023, management identified a “control failure”, which highlighted €3.89 million in duplicate payments to 2,412 GPs between 2021 and 2023, it notes. These happened during the transition from the previous diabetes care system to the current chronic disease management system.
“Although largely recovered, these duplicate payments were undetected by system controls and not self-reported by affected GPs who received the payments,” the audit found.
“The incident highlights a vulnerability in real-time payment validation controls and deficiencies in scheme transition governance and control design.”
The payment system has changed and is now increasingly complex, which “increases the inherent risk of payment errors, inconsistent claiming, and potential fraud”, the auditors noted, which creates a risk of financial losses to the HSE.
According to the audit report, the HSE referred four GPs to An Garda Síochána in 2024 due to “concerns around fraud”.
A Health Service Executive spokesman said the PCRS has “taken on board the advice and findings” of the auditors and “has active ongoing programmes to address the specific internal audit findings”.
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A separate audit on community waiting lists highlighted a “significant deterioration” in the number of patients waiting more than a year for some care types.
The State’s plan to overhaul the health system, Sláintecare, seeks to move away from hospital-based care to care delivered to patients in the community.
However, the audit on community care waiting lists points to a difficulty in providing timely access to these services.
It highlights the HSE’s “inability” to reduce the “significant and sustained length of time patients and service users are waiting” to receive care. Five disciplines – podiatry, dietetics, physiotherapy, speech and language therapy, and occupational therapy – were examined by the auditors.
The number of patients waiting longer than a year for physiotherapy increased by 38 per cent in the year to last December, while the numbers waiting for occupational therapy and speech and language therapy increased by 40 and 54 per cent respectively. Improvements were seen in podiatry and dietetics.
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“Notwithstanding the increases in long waiters across three disciplines, the number of patients seen within each therapy has declined when compared to the prior year,” the audit report found. “This indicates that, combined with reduced activity levels, demand continues to outpace capacity.”
It warned that a continued increase in patients waiting longer than a year creates “a risk of worsening patient outcomes and failure to meet access targets and core objectives of Sláintecare”.
A HSE spokesman said it “regrets” that any person would have to wait to access care and the organisation “is committed to delivering efficient high-quality services” for patients and service users.
