Family doctors paid ‘less than due’ by HSE
Chris Goodey, CEO of NAGP, said at a meeting in Cork this week that he was made aware of one Cork doctor who was offered €13,000 by way of settlement by the HSE for a claim that was in the region of €70,000 for out-of-hours services.
Mr Goodey said there was “no legal basis” for offering doctors less than their due, but that some GPs were settling because they were under severe financial pressure.
“The HSE is clearly over budget [by €75m at the end of July] and is trying to control spending,” said Mr Goodey.
GPs in dispute with the HSE over outstanding claims received a letter last month saying they had until Oct 31 to accept settlement or appeal.
RTÉ News reported yesterday that the HSE has sought a “haircut” of about 80% in some cases to claims that go back several years.
In a letter this month to a GP who has claimed €186,000 in back fees, the HSE offered a full and final settlement of just €15,000.
However, the Irish Medical Organisation yesterday said the vast majority of the 2,200 GPs who treat medical card patients and provide out-of-hours services are “not in dispute with the HSE over the payments they receive for these services”.
The IMO said the problem was restricted to a small number who are “unable to resolve their difficulties with the HSE despite protracted efforts to do so”.
The HSE said the matter was the subject of discussions with the IMO in recent years and, earlier this year, a binding mediation process was entered into by both parties. The HSE said this had led to an agreement on legacy unpaid claims.
From Feb 2011 to July 2013, 440,748 out-of-hours claims were submitted to the HSE by 264 doctors. Of these, payment was withheld in respect of 62,966 claims.
The HSE said that, under the mediation agreement, it agreed to pay 211 GPs the full amount of their unpaid claims, totalling €537,169. A partial payment has been offered to the remaining 53 GPs, totalling €377,204 in respect of 28,543 claims. GPs have until the end of October to accept the settlement offer “or exercise their right to appeal to the independent mediator in accordance with the agreement”, the HSE said.
Out-of-hours claims can only be made where the consultation is urgent and could not be foreseen and the consultation could not be deferred until GP services are routinely available.
Special items of service in out-of-hours consultations attract separate fees. They include vaccination, excisions, suturing of cuts and lacerations, ECG treatments, and asthma care.
The dispute over claiming patterns arose out of a HSE review in 2009 which gave rise to an audit where the accuracy of some claims could not be verified.
The HSE said it issued guidelines to all GMS doctors “on what constitutes an eligible claim and claiming patterns for some doctors have altered significantly”.
