Hospitals and doctors overcharged VHI by €7m

VHI, the State’s largest health insurer, recouped almost €7 million last year on foot of investigations into overcharging or erroneous payments to hospitals and doctors.

The company said that overall it recovered €10.5 million through the actions of its special claims investigation unit (€6.9 million) and its third party recovery process (€3.6 million).

However it said that it did not reveal details of the identities of the hospitals and doctors found to have been overcharging although the sums involved had to be repaid. It said none of the cases of overcharging had been referred to the Garda.

"Vhi Healthcare is committed to managing costs and reducing inefficiencies," it said, adding that its special claims investigations unit (SIU) had recouped a total of €30 million since its establishment in 2006.

This “forms a critical element in the overall cost containment strategy . . This unit is very active and has uncovered a number of cases of what we believe are overcharging .”

The insurer said: “In addition to the SIU, we have a number of robust measures in place to ensure benefit paid on behalf of our customers is appropriate and warranted including pre-verification of claims, data analytics, ongoing audits, third-party recovery, clinical reviews and utilisation management.”

VHI said that when it spoke of incidences of error or overcharging by healthcare providers, it referred to both hospitals and hospital consultants.

Each case was “rigorously investigated and where overcharging occurs, providers must pay back the money involved and introduce a number of corrective measures to ensure that this does not arise again”.

“Inappropriate charging in the health insurance industry is a feature worldwide and all international health insurance companies continue to fight this and are committing additional resources to this area .”

The insurer said it had provided more resources to the SIU. “In 2012, a total of €10.5 million was recovered through the actions of both our special claims investigation unit and our third-party recovery process.”

VHI has increased subscriptions five times over the last last two years or so. The company has attributed the rise in premium costs in part to the increasing volume and cost of claims.