Half of €100 emergency charges sent to exempt patients

Health Minister James Reilly may have to rethink the controversial €100 emergency department charge after it emerged up to half of the bills are sent to patients who are exempt from payment.

An analysis of the charge, introduced in 2009 as the recession was taking hold, said there is an inherent risk in how patients are targeted — meaning the scheme may need to be revamped for the benefit of hospitals and patients.

The conclusion was drawn by the HSE’s own internal audit division after they examined four hospitals in the south-east.

The Freedom of Information Act report focused on the success rate of the charges system at Waterford Regional, Wexford General, St Luke’s in Kilkenny and South Tipperary General.

It found while the charges help to keep people who should not be attending emergency departments away from the crowded units, up to half of the fees later have to be cancelled because they are unfairly targeting patients who are exempt from paying.

An analysis of the emergency department charges from 2011 showed Wexford General had to cancel 50% of the charges, a figure which equated to €359,555.

Waterford Regional (42% of invoices cancelled which would have totalled €423,367); St Luke’s (28%, €155,070); and South Tipperary (30%, €145,016) reported similar issues.

Among the reasons why the invoices were binned were:

* Patient was ultimately admitted to a ward.

* Patient held a medical card.

* Patient received a backdated GP referral letter.

* Patient subsequently did not want to be seen.

* Patient was pregnant.

The audit said that this was proof the emergency department charge system needs to be revamped to ensure the right people are being targeted.

“As invoices are generated at time of attendance, there is an inherent risk invoices will be raised for patients who are not liable for the charge,” the report warned.

The fees system has become a major cause of controversy since it was introduced in 2009, with people refusing to pay the charges even when they have no legal defence.

The situation is resulting in tens of millions of euro being written off nationally every year as bad debt.

According to the audit, 86% of charges at the four hospitals examined were referred to debt collectors during the period in question.

The audit team noted while the four facilities used the same debt collection agencies, the external companies charged different rates for standard services depending on the hospital — and sometimes failed to provide proof of their standards.

“The fees charged by the debt collection agencies varied where locations used the same agency on a regular basis,” the report said.

Without naming the facilities, it added that “debt collection rules and performance by the debt collection agencies is not being appropriately monitored” at two of the four hospitals examined.

The audit also noted the facilities appear to be making a conscious effort to delay resorting to debt collectors until it is absolutely necessary.

Despite HSE rules stating reminder letters about the fees must be sent out within seven days, final reminders within 14, a 10-day letter within 21 and referral to a debt collector by 28, this is not happening.

When records were examined, it was found the hospitals delayed contacting a debt collector until 55-74 days — far in excess of the HSE’s own guidelines.