Oireachtas Joint and Select Committees
Thursday, 19 October 2023
Public Accounts Committee
Children’s Health Ireland and National Paediatric Hospital Development Board: Discussion
9:30 am
Mr. Stephen Flanagan:
I will take that. Under a memorandum of understanding between the HSE, including CHI, and the VHI insurers, there is an agreement in place where private claims are essentially paid upfront to the relevant healthcare institution and then there is a nine-month period under which you are required to provide the full submission to them. In some of these instances, the claims and coverage are complex, and the additional services which would become part of the claim are also varied. Then there are other challenges in terms of getting the relevant approvals from clinical teams, etc, who move around different entities for us.
In this instance, there was a loss of income for claims that would have either submitted after the deadline or submitted and were seen as not valid. There would have been a recoupment of those amounts if the claim was genuine.