My predecessor last reported to the committee on this matter in September 2003. At that stage, an extensive exercise had been conducted by the former health boards which had resulted in the removal of some 80,931 records from the GMS medical card register. These records related to clients aged more than 65 years of age, of which 72,945 records related to persons aged over 70 years.
Based on guidelines agreed with the former health boards for this exercise, not all records would have generated an overpayment. The bulk of them would have related to normal activity, such as removal due to death or a person moving from one board area to another. Of the remainder, a total of 28,156 records were more than three months on the register at that time and would have generated an overpayment. The estimated overpayment in September 2003 amounted to €8.294 million. This broke down into €7.54 million in respect of capitation payments and €754,000 in respect of superannuation. A further amount of overpayment would have occurred in the case of GP non-capitation allowances. However, as this proved extremely resource-intensive to calculate, it was not considered cost-effective to pursue the additional amount.
A commitment was also given to continue to update the GMS register and identify expired medical card records. An update was provided to the Comptroller and Auditor General in July 2004. At that stage, a total of 104,236 records had been removed from the GMS register. The number of records relating to over 70s and which were more than three months expired was just over 29,000, a slight increase on the earlier figure because the bulk of these records had been identified by September 2003. The estimated overpayment had also risen slightly to €8.468 million, of which €769,000 related to superannuation. The number of GPs involved was 1,780.
To date, the level of overpayments identified with some balancing of data amounts to approximately €9 million. The position regarding records is as reported in July 2004, which resulted from an extensive examination of the 104,236 records that were removed from the database in the period, from February 2002 to February 2004, that was agreed for this exercise.
In line with the commitment given to the committee in September 2003, the Department and the HSE undertook to recoup the amount of overpayment identified. However, the IMO resisted recoupment of overpayments and maintained, as the Comptroller and Auditor General pointed out, that GPs have been underpaid for certain other categories of medical card clients under 65. Given the strong probability of a legal challenge, the Department agreed to have the alleged underpayments examined. This further examination got under way in mid-2004, when terms of reference were eventually agreed with the IMO. A draft report of the alleged underpayments, carried out by the same dedicated HSE or former health board-led team, was provided to my Department in March 2005.
Potential underpayments have been examined with regard to three principal categories relating to delayed registration of infants, removal of young adults from the GMS register at age 16 and interruption of eligibility due to failure to meet a review request. The underpayment amounts to €1.8 million with regard to these three categories. In addition, a number of other categories identified by the IMO have been accepted for examination. Among these are out of hours and special-type consultation claims, which were not complete and which were not paid. The task of calculating the value of underpayments in these and other related areas is much more complex. An estimate of the value has been made and is being independently quality-assured at present. It is expected that this process will be completed within the next two to three weeks. On the basis that all of the areas of alleged underpayments are accepted by the HSE and the Department on completion of the exercise, it is expected that the amount of underpayments will increase significantly and that the net overpayment will reduce accordingly.
With regard to ongoing management of the databases, the HSE team has expressed its satisfaction that the focused work on the data cleansing has removed the expired records and duplicates. The HSE, through the schemes modernisation project, has produced a management and control document which sets out a standard national framework for managing the medical card database and ensuring data integrity and currency. Minimising the risk of duplicates being created on the system is being addressed on an ongoing basis through standard management and control procedures. However, eliminating this risk ex-ante will only be achieved when the national schemes client index is fully implemented and applicants can be uniquely identified at a national level. The national schemes modernisation and national client index projects have been progressing this agenda and some 95% of cardholders on the medical card register now have a valid PPSN assigned to them.
This is very significant progress in terms of the preparatory work that needs to be done in advance of implementing a national schemes client index, as the PPSN will be the unique identifier for the future. Proposals for moving towards a single national schemes IT system are currently under active consideration by the schemes' modernisation project team. The implementation of a national schemes IT system allied to the implementation of a schemes client index will significantly improve the performance of schemes both from a customer services perspective and from a management and control perspective.
Other enhancements are being progressed through the two projects such as a national medical card assessment guidelines document, which is currently under consideration by the Department, the introduction of a standard national medical card application form and the implementation of a national standard training programme for staff involved in administering the medical card scheme throughout the HSE. Overall, the HSE has assured the Department that management of the database and removal of records as they expire is more robust. Evidence of this is borne out by the number of eligibilities expired each month, resulting in the overall increase in cards currently being low. Regarding the drugs payments scheme refunds, the position is basically as set out by the Comptroller and Auditor General. This scheme has been brought to a conclusion.
My statement was prepared so that it would be ready for the committee but I believe my predecessor touched on the fact that overpayments to GPs are part of a wider industrial relations process. Some of my colleagues have spent the past two full days on that matter, right up to late last night. I could, therefore, offer some update on that, if the committee wishes.