Catherine Noone (Fine Gael)
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I wish to ask the Minister for Health to put a procedure in place for the cancellation of a medical card number when issuing a death certificate. It is a simple concept. Recent reports in the IrishIndependent highlighted the problem of GPs claiming more than €1.5 million a year in fees for people who were dead or did not exist. Even prior to that there was a clear need to establish a work practice to increase efficiency. Given that the Minister has said there is no more fat left to cut, this seems to be a simple procedure which could help to us save money. I discussed the matter with the Minister and it was also discussed at today's meeting of the Fine Gael Parliamentary Party. The Minister mentioned that sanctions could be put in place for doctors who did not take people off their medical card lists when they knew a person was deceased. That was in the context of negotiations to allow GPs put babies on their lists. In a sense it was a quid pro quo, in that they would be given discretion to put people on their lists, but they also had to be seen to take them off them at the other side, for want of a better phrase.

There is a much wider debate whereby we could receive more information in-house. There is a responsibility on families when a person dies to return pension books and provide Departments with various information. There is even an onus on them to return medication for safety reasons. One can understand why there might be a difficulty between Departments. A well known comedy show springs to mind in this context where a girl sits opposite the person asking a question and the response is “Computer says no.” In this case we are talking about one Department that has all of the information at its disposal. One organisation, namely, the HSE, issues death certificates and medical cards. Surely to goodness we need some joined-up thinking in this regard.

Alex White (Dublin South, Labour)
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I thank the Senator for raising this issue. Medical card processing was centralised at the Primary Care Reimbursement Service, PCRS, office from July 2011. This central processing is single national governance, with a central office location to replace the 100 locations used in the past. This national project provides for an enhanced service delivery to clients and a consistent and equitable national assessment process. The system now facilitates standardised, homogeneous and equitable assessment of all applications, irrespective of the origin or nature of the application.

Since centralisation, the HSE has in place a system for the processing of death information based on the death event publication service, DEPS, operated by the General Register Office. Under the systems applying, the HSE obtains a file of deaths each week which is uploaded to the medical card database. While there may be a delay in recording a death with the General Register Office, amounts paid to GPs after the date of death are recouped from them.

It is important to note that the HSE does not rely solely on the death event publication service. One of the enhancements to the processes introduced by the HSE was an agreement with GPs that allows them to manage their medical card panel more proactively. In this regard, they can confirm that their medical card panels are, to the best of their knowledge, correct on a quarterly basis. In addition, they can remove a medical card holder from their panel where they are satisfied that the individual has passed away or is no longer resident in Ireland. Individuals can also contact the HSE directly to notify it of the death of a family member and the HSE's own staff monitor these matters.

Legislation which came into effect in March 2013 - the Health (Alteration of Criteria for Eligibility) Act 2013 - allows the sharing of data between the Revenue Commissioners, the Department of Social Protection and the HSE. The introduction of these additional controls will strengthen the risk management framework for schemes and provide additional support. Overall, the centralisation of the medical card system and the new measures, involving verification by GPs of their medical card lists every three months and the removal of deceased individuals from panels, ensures payments are not being made to GPs for people who are deceased or no longer eligible due to their having emigrated.

Catherine Noone (Fine Gael)
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It seems that when the information is available in-house, it is unnecessary to put the onus on doctors to be responsible for making sure their own lists are in order when we have the information available when a death certificate is issued. I am not convinced on the issue, but there is no point in pressing it.

Alex White (Dublin South, Labour)
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I thank the Senator. The opportunity GPs have to update the system is just one of the methods used to update the system. As I indicated, the HSE has the DEPS system in place and it should work. The involvement of GPs should be an additional safety net. The Senator is correct that the system should ensure updating occurs and that we should rely on GPs and others involved in the system to ensure everything is done properly.