The country’s largest health insurer has said it saved nearly €7 million last year as a result of investigations into incorrect or inappropriate invoicing by hospitals, doctors and other healthcare providers to the VHI.
VHI chief executive Declan Moran said the savings were recouped as a result of a planned programme of billing audits by the company’s special claims investigation unit (SUI) as well as an ongoing initiative that queried the appropriateness of claims for patients with prolonged hospital admissions.
He said there were also approximately 2,000 contacts from “vigilant customers who queried their claims assessment statements”.
Mr Moran said where money was due it was recouped in full.
“In 44 per cent of the cases reported the full 100 per cent of the money paid out was due for recovery . The savings, which amounted to nearly €7 millon, have been invested into providing more healthcare for our customers, including more affordable healthcare premiums.”
Mr Moran said the most common anomalies identified last year were: incorrect accommodation fees being invoiced by the hospital (for example where a patient was billed for a private room when the patient had actually occupied a semi-private room); inappropriate lengths of stay; charges being raised for cancelled procedures; private fees for patients treated in a public capacity; as well as inappropriate invoicing for certain specified drugs, tests and prostheses.
“While Vhi Healthcare has always had a claims investigation team, significant additional resources have been invested in the SIU team over the past two years, and this has resulted in a doubling of monies recovered, year on year. From a cost containment and value-for-money perspective this initiative has been very successful with a 10:1 return on our investment to date . During 2011 we widened the scope of the SIU to greatly increase the number of onsite provider audits being completed," he said.
