Background: Millions of euros in overpayments have been paid to doctors for medical card patients due to admistrative errors, writes Carl O'Brien
Thousands of duplicated records, deceased patients on official registers and inaccurate databases have resulted in health boards paying out millions of euro in excess payments to doctors.
The appalling standard of record-keeping offers a glimpse into the black hole which many say is responsible for swallowing up funding increases in the health services.
Ironically, no one can accurately tell how much has been paid out to doctors for "ghost patients" because records have been so poorly kept.
The Comptroller and Auditor General has estimated that doctors received around €12 million annually due to the record-keeping discrepancies, but the Department of Health says it is closer to €6 million.
Alarm bells first started ringing over the standard of records when the cost of offering free medical cards on the General Medical Services (GMS) scheme to everyone over 70 years of age spiralled beyond projection, after the scheme was introduced in 2001.
The decision to introduce automatic eligibility for the age group was made just days before the Budget, and cost estimates were hastily calculated. Department of Health files show the original forecast cost of the extra medical cards was €19m, based on an extra 39,000 over-70s becoming eligible.
Within months, however, more than 70,000 older people were claiming medical cards, and the cost of the scheme had ballooned to €51 million.
There were clearly major differences between the census statistics and health board records. This led to a "cleansing" of the entire GMS scheme. So far, around 63,500 patients have been struck off the medical register. Figures released under the Freedom of Information Act show the majority were inaccurately recorded as card-holders for less than a year, while 13,250 patients were incorrectly registered for between one and five years, and 1,230 for between five and 14 years or more. Doctors have been receiving, on average, €2,296 in excess payments.
The standard of record-keeping has varied from health board to health board. On average, GPs in the Eastern Regional Health Authority received the highest amount, €3,651, while doctors in the North Western Health Board received €348.
Doctors argue that if inaccurate records meant they were overpaid, chances are they were underpaid as well.
Delays in issuing and re-registering medical cards for some age groups mean there is a tradition of treating for free patients from poorer backgrounds who don't necessarily have a medical card.
As a result, it is questionable whether the Department of Health will push ahead with its plans to recoup the overpayments from doctors, knowing that a thorough trawl of potential underpayments could result in a net loss to the State.
While the focus has remained on health boards, the Department also appears to have questions to answer over the failure to maintain accurate records.
As early as 1998, when a new plastic medical card was issued, discrepancies with GMS records became apparent and 30,000 patients were struck off the list. Despite this, the Department of Health never asked the boards to conduct a wide-ranging "cleansing" exercise.
Doctors, too, cannot be absolved from blame. Some admit they haven't been proactive in helping health boards maintain accurate records because they claim it makes up for their underpayment. The Department now says a new centralised system is being introduced to ensure records are more accurately maintained. However, now that the millions have disappeared, it is difficult to see how they will ever be fully recouped.