Written answers
Tuesday, 27 May 2014
Department of Health
Health Insurance Claims
Clare Daly (Dublin North, United Left)
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743. To ask the Minister for Health the reason a VHI policy was used to pay a consultant who did not in fact visit or tend to the patient in any way. [22340/14]
James Reilly (Dublin North, Fine Gael)
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VHI issues a Statement of Benefit to each customer detailing the payments made by VHI on their behalf, and urging the customer to be vigilant when examining their claims statements to ensure that there are no anomalies. Customers are advised to contact VHI's Special Investigation Unit (SIU) if they think that there is a mistake on their statement or if VHI has been charged for accommodation or treatments not received. The SIU team at VHI is dedicated to ensuring that incidences of error or overcharging by healthcare providers are fully investigated and rectified.
Where an error has been identified, VHI notifies the provider in question and deducts the monies involved directly from the provider. The provider is also asked to ensure that their processes are amended to prevent any recurrence. If there are a number of queries or repeat occurrences of anomalies with a particular hospital or service provider, an audit is conducted to identify the extent of the practice, the level of monies to be repaid to VHI, and the redesign of processes to prevent any reoccurrence of inappropriate billing.
I understand that the case referred to by the Deputy was investigated by the VHI in accordance with its procedures for handing such complaints.
Clare Daly (Dublin North, United Left)
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744. To ask the Minister for Health the remedy available to persons who have made a claim or who believe that medical practitioners fraudulently claimed for expenses in relation to their case; the action they can take regarding same; and his plans to reform the system. [22341/14]
James Reilly (Dublin North, Fine Gael)
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I assume the Deputy is referring to claims by medical practitioners in respect of treatments paid for by private health insurers.
I do not have a role in the day to day operations of any private health insurance company. However, it is my understanding that each of the private health insurance companies has its own procedures in place to investigate instances where over-charging of customers for hospital treatments is identified and notified to the insurer.
Customers of private health insurers should contact their private health insurance company in the first instance if they are not satisfied with their statements or if their insurer has been charged for accommodation or treatments not received. It is then a matter for the private health insurer to ensure that necessary steps are taken to investigate and deal appropriately with the issues identified.
I have emphasised the importance of cost control in relation to private health insurers. The independent report prepared by Pat McLoughlin deals extensively with this matter, including the need for insurers to co-operate on addressing fraud, waste and abuse. Mr. McLoughlin's second and final report is expected during June.
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