Health insurers owe nearly €300m to publicly-funded hospitals

Hospitals waiting up to 163 days in some cases for doctors to sign off on forms

Publicly-funded hospitals are owed nearly €300 million by health insurance companies arising from treatment provided to their subscribers, the Comptroller and Auditor General (C&AG) Seamus McCarthy has found. Photograph: Frank Miller/The Irish Times.

Publicly-funded hospitals are owed nearly €300 million by health insurance companies arising from treatment provided to their subscribers, the Comptroller and Auditor General (C&AG) Seamus McCarthy has found. Photograph: Frank Miller/The Irish Times.

 

Publicly-funded hospitals are owed nearly €300 million by health insurance companies arising from treatment provided to their subscribers , the Comptroller and Auditor General (C&AG) has found.

The C&AG’s report says delays in collecting income from private health insurers means the exchequer is “effectively meeting the funding gap at hospitals until payment is made”.

It says the amount outstanding at the end of last year is composed of €172 million owed to HSE hospitals and €118 million to State-funded public voluntary institutions.

The report also indicates that despite a number of intiatives by health service management in getting consultants to sign off on claims to be submitted to insurance companies in a more timely fashion, the problem had gotten worse in some cases.

It says “timeliness of sign off by consultants varies greatly by hospital, ranging from a high of 163 days to a low of 15 days at December 2014”.

The C&AG’s report says an examination of a sample of the highest value claims for the top ten consultants (ranked by value of claims outstanding) awaiting sign-off in five hospitals visited found the majority had been held up for more than two months.

It says hospitals are “not always aware of the reasons for delays in consultant sign-off, as consultants are not required to provide explanations”. It also maintains no formal action had been taken by the hospitals where consultants were consistently late in submitting claims.

“At the end of 2014, claims had been with consultants for an average of 58 days – 68 days in HSE statutory hospitals and 47 days in voluntary hospitals,” the report says. “This is well above the target of 20 days agreed with consultants as part of the Labour Relations Commission agreement in September 2012, and the revised temporary target of 30 calendar days adopted by the HSE in November 2013.”

The report says the HSE noted that because the changes resulted in an increase in the number of claims requiring consultant review, “the implementation of the revised legislation contributed to delays at the consultant sign-off stage in 2014”.

“The HSE does not currently produce management information in relation to the value and age of debt awaiting sign off for each individual consultant. Instead, this information is produced at the hospital level.”

The C&AG’s report urges the HSE to develop management reports which measure individual consultant’s compliance with the target times for sign off of insurance claims.

“Such reports would allow the HSE and the hospitals to monitor performance more accurately and to take action, where required.”

The report also states the value of claims queried by insurance companies increased by 69 per cent during 2014.

It says the sharp increase in queried claims appears to be the result of changes in the charging regime introduced at the beginning of last year and additional information being requested from consultants to justify the length of stay of the patient.

“The HSE should agree clearly defined terms of payment and payment processes with the insurance companies. This will ensure that the claims being submitted by the hospitals are complete and can be processed efficiently by the insurance companies with a minimum of queries arising post submission.”

The comptroller’s report also states that HSE hospitals wrote off €4.6 million owed in private patient charges last year.