C&AG report: Department of Social Protection losing out because of a lack of medical assessors

The Department of Social Protection could be making weekly overpayments of almost €2m on illness benefits schemes and the invalidity pension.

The C&AG Annual Report chapter of ‘Regularity of Social Welfare Payments’ said there appeared to be little fraud and that the reason for overpayments of some benefits was due to people becoming medically ineligible — failing to meet the criteria for the payment because their condition improved.

However, while the C&AG cites a “lack of timely medical review” for much of the estimated overpayment of certain benefits, the annual report notes that the Department is struggling to hire additional medical assessors to carry out the work.

According to the report, the Department seeks to identify excess payment, and where a deciding officer finds that an overpayment has occurred, it will seek to recover the money from the claimant.

It has conducted a number of fraud and error surveys across various social welfare schemes, but reviews of some payments have not taken place in recent years.

According to the report, there has been an historical high level of excess payment for the disability allowance, illness benefit and invalidity pension schemes, but if medically ineligible cases were excluded, the overpayment rates would have been drastically reduced.

Last November, a random sample of 1,000 illness benefit claims were reviewed, 300 of which were then medically assessed.

According to the C&AG Report: “Based on the survey results, the Department estimated that the weekly gross amount of excess payment in the illness benefit scheme was €1.5m.”

However, just a handful of cases involved suspected fraud, and instead were deemed cases where recipients had become medically ineligible for the payment.

Meanwhile, a parallel survey of 1,000 claims to the invalidity pension, again with 300 cases medically assessed, led the Department to estimate that the weekly gross amount of excess payment in that scheme was €348,000.

The C&AG said this indicates a “lack of timely medical review” at a time when, for example, disability allowance is receiving 37% more new claims per week this year than in 2012.

It recommended increased controls but revealed: “It is an ongoing challenge for the Department to maintain current numbers of medical assessors and it is proving extremely difficult to recruit and retain replacement or additional medical assessors.”