Private patients ‘fraudulently billed’ for beds
He said it was “commonplace” for private patients to be admitted to public beds but for the hospital to bill the insurer for private care regardless. The consultant ophthalmologist, who works in the Mater Hospital in Dublin, said hospitals were doing this because they were “desperate for money”.
He also claimed hospitals were engaged in retrospective billing, with consultants expected to recollect whether patients treated years previously had been public or private.
“They are broke and anything they can do, they’ll do to get it and the VHI and all the other insurance companies are the huge target.”
Yesterday, VHI, while conceding that some hospitals had billed patients inappropriately, refused to say who the guilty parties were.
Prof O’Keefe described the practice as a “complete abuse” of the patient and said if he was billing patients in this manner, he would consider that he was “committing a criminal offence”.
He could expect to be up before the Medical Council and with “a possibility of charges” against him, Prof O’Keefe said yesterday on Today with Pat Kenny.
The VHI chief, John O’Dwyer, accepted there had been some “inappropriate billing,” but said it was not VHI practice to “pay for somebody on a trolley”.
He said they “phoned thousands of customers every year to verify they did occupy a bed” and that in “many cases where there has been some inappropriate billing, we have got significant returns”.
In a follow-up statement yesterday, VHI said it took “reports of inappropriate billing extremely seriously” and had a special investigations unit that specifically deals with this area.
Prof O’Keefe said the reality was that private patients were funding the public hospital system while “getting nothing extra” for the substantial insurance premiums they paid, premiums, he said, which were set to soar when the Government legislates for insurers to pay the full cost for use by a private patient of a public bed.
The effect would be further patients cancelling private insurance and job losses in the sector, he said.
In a statement, the Department of Health said legislation to provide for charges to be collected from private in-patients who occupy public beds was expected to be enacted by the summer, but that the charge would be phased in over a number of years “to mitigate the impact on the private health insurance market”.
A statement from the HSE said hospitals “constantly review billing systems to ensure all appropriate charges have been levied correctly and that claim forms have been completed, signed by the treating consultant and submitted to the insurer”.
The department said not charging private patients treated privately in a public bed maintenance costs represented “a significant loss of income to the public hospital system and an indirect subsidy to private insurance companies”.
Private patients in public hospitals accommodated in private beds are subject to maintenance charges ranging from €586 to €1,046.
