A special investigation unit set up by the VHI has resulted in almost €2 million in erroneous claims, which had been paid out to hospitals and doctors, being recouped, it was confirmed yesterday.
The errors were brought to the attention of the health insurer by patients after they spotted mistakes on bills it paid on their behalf after undergoing treatment. In one case, the VHI recouped €1,962.53 from a hospital which billed it for a procedure on a member which was scheduled to take place in February 2009 but had been cancelled – the claim for payment was submitted anyway. The patient contacted the VHI’s special investigation unit and the money was recouped from the hospital.
In another case, €1,100 was recouped from a hospital after it billed the VHI and was paid for two nights’ semi-private accommodation for a patient. On receiving a copy of the bill, the patient contacted the VHI to say she was admitted as a public patient.
In a further case, a consultant filled in the wrong code for a procedure when billing the VHI which resulted in the doctor being overpaid by €751. This was also recouped after the patient drew the VHI’s attention to it.
The VHI is now urging all members to check their bills so that further instances of billing errors or overcharging, which drive up insurance premiums, can be avoided.
It said €1.9 million had been recouped since its special investigation unit was established in 2005, which is roughly €500,000 a year.
About 2,500 queries on statements and bills are raised by patients each year. Of these, 50 per cent are found to have an issue to answer with funds recovered in all of those cases. But overall the level of queries raised is small in the context of the 700,000 or so bills settled. The value of claims paid out would amount to about €1 billion a year.
The company stressed it already had a robust claims assessment process in place but it hoped additional billing errors would be picked up if patients themselves were more vigilant.
The VHI said when patients were checking their statements they should look out for mistakes in the accommodation type (public, semi-private, private) as well as the number of nights billed for, incorrect procedures being charged for or being charged for services not provided, such as an epidural, or a procedure which was scheduled but cancelled.
Members who notice such errors can contact the VHI’s special investigation unit by phoning 1850-444444 or e-mailing siu@vhi.ie