Wednesday, May 02, 2007

Is the Health System defrauding the VHI?

On Thursday last, the Irish Independent reported that hospital consultants earned €237m from VHI alone in the past year.

The previous week, the Comptroller & Auditor General reported that private patients occupy more than the stipulated 20% of beds in public hospitals. On RTE radio, a spokeswoman for the IHCA offered one possible explanation for the excess private patients: it appears to be the practice in some hospitals to ask patients in A&E if they had private health insurance. If the answer is yes, the patient is asked to sign a claim form and is then categorised as private rather than public patient.

Presumably the purpose and result of this practice is to allow both the hospital and a consultant to bill the health insurer for accommodation and medical services provided.

I have been a PSRI payer and a VHI subscriber for over 30 years. I am entitled to a wide range of medical services as a public patient. If I present to A&E with a problem and am subsequently admitted to a public ward, I expect that this will be covered by my PRSI entitlements. If all I receive is public patient treatment, I should not be expected to use my VHI cover to pay for this. If I opt for a private or semi-private room, the hospital itself may justify seeking payment from VHI, but why should VHI pay the consultant who would be treating me regardless of which bed option I choose?

If hospitals and consultants are operating the system in this manner, then surely it may constitute a fraud against the VHI and its premium paying members? The nursing home fraud is currently being resolved, will VHI members soon be getting refund cheques courtesy of the Dept of Health?

Clearly if both hospitals and consultants were only paid by VHI for genuinely private treatment, the cost of health insurance would fall dramatically, the cost of risk equalisation would greatly reduce and the health insurance market could be opened up for real competition and product innovation.

VHI needs to clarify exactly what it pays on its members behalf and advise us on how to treat claim forms presented for signature in hospitals.

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