Patients pursued in error for CUH bills

Hospital debt collectors are wrongly chasing medical card holders, people who failed to be seen by a doctor, and even the dead for emergency department fees.

HSE internal audit files seen by the Irish Examiner show the situation is occurring at Cork University Hospital despite clear rules stipulating who is exempt from the €100 attendance charge.

Documents released in recent days confirm that, like other hospitals, CUH is making upwards of €500,000 every year on emergency department attendance fees.

However, due to a series of safety errors, it is wrongly chasing medical card holders, people who were not even seen by doctors, and a small number of patients who died for bills that should not exist.

According to the files, in the first eight months of 2012, CUH had to write off €176,951 in wrongly charged bills to exempt patients, including €125,240 to medical card holders, some of whom suffer from serious conditions.

Due to administrative mistakes, the individuals had been billed for attending the emergency department, with their details sent on to a hospital-contracted debt collection agency when the money was not paid.

While the issues should have been resolved within 70 days, the audit found that, in many cases, this did not occur.

As a result, already vulnerable patients — at least one of whom ultimately paid the €100 charge in 10 weekly instalments of €10 each — were put under further pressure to pay charges they should never have been given.

In all, 1,096 cases were checked by the audit team. Of these, just 190 people were eligible for an emergency department fee — with 136 medical card holders, 576 people referred to hospital by their GP, and 20 people never seen by a medic at CUH wrongly told to pay.

The HSE audit team noted: “Patient eligibility, particularly patients with medical card status, is not always captured on patient registration.

“Accounts raised are not vetted before dispatch to ensure they are completed or warranted.

“As a result, invoices are issued to patients that are exempt from charges, their details are sent to a debt collection agency, and letters indicating possible legal action are sent out.”

The audit team said it is essential that emergency department staff are given full access to national patient databases to ensure no one is wrongly charged for attending the units.

It said the eligibility status of all attendees must be, “as far as practicable, checked and validated to ensure invoices are not issued to exempt patients and to avoid their inclusion in the debt collection process”.

A previous HSE internal audit report last year questioned the reasoning behind Health Minister James Reilly’s €100 emergency department charge policy, noting that half of bills sent out by hospitals are in fact linked to exempt patients.


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