Report: Hospitals, doctors defrauding insurers

Hospitals and doctors are fraudulently claiming millions of euro from insurers for non-existent treatment of patients in their care.

The situation, which includes claims for “semi-private” support when a patient has been on a trolley, is revealed in an independent report commissioned by the Department of Health.

The document was published just a week after independent senator and cancer oncologist Prof John Crown revealed that St Vincent’s Hospital wrongly charged VHI €1m for drug-related claims more than a decade ago.

According to the document, which can be read at irishexaminer.com:

* Hospitals are asking insurers to pay for semi-private accommodation for patients when they have been treated on a trolley;

* Some insurers are paying private patient fees when they have been cared for in a public facility;

* Some hospitals are invoicing for patient stays in excess of the actual time a person was at the facility, while others are filing “inappropriate” invoices for drugs, tests, and prostheses;

* Some consultants are making claims for treatments despite not being present when the procedures took place

The report said the money- making moves are fraudulent and must be addressed immediately before they undermine the private health insurance sector.

The incidents are also contributing to a surge in costs for people who take out private health cover, as insurers attempt to balance their books by increasing premium prices.

As a result of the incidents, the Government-commissioned document has recommended that health insurers adopt a “co-ordinated” approach to tackling fraud in the market by the end of March.

This should include an industry-funded whistleblower initiative allowing for anonymous online reporting of potential issues, fraud hotlines, and public awareness campaigns.

The document, which focussed on a number of other ways the health insurance market can legitimately bring costs under control, was drawn up by Pat McLoughlin, chief executive of the Irish Payment Services Organisation and a former deputy CEO of the HSE.


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