Report: HSE losing almost €400m in unpaid hospital bills

The Health Service is losing out on up to €394m in unpaid bills for private care – almost half its budget savings.

In a damning report, the Government’s spending watchdog today revealed half of private patients are not being charged for treatment and a further €164m in payments is late.

Effectively more than 200,000 people were last year given private care status in everything but name, the Comptroller & Auditor General’s report found.

Better-off patients were being cared for in single or twin-bed rooms with consultants claiming fees for their work yet the State could not bill insurance firms.

“The full economic cost of maintenance is not being levied,” the C&AG John Buckley said.

In a shocking audit of 24 hospitals – half the country’s hospital care centres - Mr Buckley uncovered,

:: 205,203 private patients put in public or non-designated beds.

:: Hospitals should have charged a maximum of €758 a night.

:: And up to €153m should have been paid to the HSE for this care.

The figures reflect unpaid fees for less than half the country’s hospitals but Mr Buckley said the study indicated such practices right across the health system.

When doubled the total unbilled hospital care could be more than €307m.

The report showed a further €87m has not been paid due to delays in getting invoices and medical reports signed off by consultants and an out-dated paper-based system.

These unpaid bills are just shy of half the €800m savings the HSE has been ordered to find this year.

Jan O’Sullivan, Labour’s health spokeswoman, said outstanding bills are unacceptable and claimed the health system was broken beyond repair.

“It is high time that we moved away from the dysfunctional, public/private hybrid, two-tier system that we currently have, to one where all patients receive the same high quality treatment,” she said.

The Limerick TD said the unpaid bills were entirely unacceptable.

John Buckley warned that the present system of bed allocation and charging was effectively failing the State.

“The designated beds system that is operated limits the extent to which maintenance charges can be recovered, even for patients who pay their consultants on a private fee basis for treatment charges,” he said.

During the audit, the HSE told the C&AG it was limited in when and what it could charge for, noting difficulties when patients are treated in isolation, in coronary heart wards and over the length of time a private patient may be in a private bed.

The executive’s accounting officer claimed there has been no review of how beds are designated since the 1990s and warned hundreds more have been added without being formally designated public or private.

Single or twin-bed rooms, private in everything but name, cannot even be charged to insurers because they have not been officially designated, the HSE said.

Despite these limitations consultants can claim fees for treating a private patient in one of the non-designated rooms.

The HSE said there was a growing use of designated private rooms for public patients to control infection which increased losses from private care.

And health chiefs said they are in talks with the Department of Health on bed designation to avoid a repeat of the losses.

The C&AG report also warned the complicated bed designation system will be further complicated by the hospital consultants’ contract which limits the number of private patients a doctor can treat in a public unit.


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