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Medical cards payments crackdown demanded

29 Nov 2013

By Gary Culliton

The HSE has not yet developed an estimate of the level of excess payments in the medical card system, it has emerged. The cost of “a material level of ineligible medical card holding has not been established,” the Comptroller and Auditor General, Seamus McCarthy has said.

The Comptroller has recommended that the HSE initiate a “cyclical programme of reviews of eligibility” in respect of random samples of cardholders. This would allow “a reliable baseline estimate of the scale of excess payments to be identified,” McCarthy told the Dáil Public Accounts Committee.

Demanding that “prescribed controls are applied”, he called for additional guidance and staff training, as well as more formal supervisory reviews of medical card approvals. Tracking changes in the levels of excess payments would allow the HSE “to evaluate the effectiveness of its overall control strategy”, McCarthy said.

It would enable the reasons for excess payments to be identified.

In 2012, the HSE engaged consultants to review excess payments within the medical card scheme.

They estimated that this expenditure could be in the range of e65 million to e210 million per year. However, that review was limited in scope as it was conducted on the basis of a review of reports, rather than a detailed analysis of the database.

An examination has now been carried out to assess the adequacy of controls over the initial award of cards and the process of review of cards in issue. The level of ineligible card holding was also examined. Shortcomings were identified in the application of controls in 8 per cent of a sample of 2012 medical cards approved. In 4 per cent of cases, medical cards had been approved in circumstances where the available evidence suggested that the applicant had not satisfied eligibility criteria, said McCarthy. In the other cases, no documentation or inadequate documentation of outgoings had been provided. During 2012, the HSE reviewed 40,000 cards where cardholders had not accessed medical services for periods of 12 months or more. Eligibility was removed in just under 40 per cent of these cases. While these cases had not recently resulted in payments for prescriptions or other items, capitation payments to their GPs would have been incurred.

gary.culliton@imt.ie

Date: 
29 November 2013

Click here to view the full article which appeared in Irish Medical Times