Written Answers. - Medical Cards.
Denis Naughten
Ceist:
991
Mr. Naughten
asked the
Minister for Health and Children,
further to Parliamentary Question No. 310 of 24 June 2003, if he will outline the current status of the review; if board members are involved; and if he will make a statement on the matter.
[20957/03]
The review has now been completed. The Sec retary General of my Department addressed the Committee of Public Accounts on this matter on Thursday 25 September 2003. A copy of his statement for the Deputy's information accompanies this reply.
GMS Medical Card OverpaymentsI welcome the opportunity to bring the committee up to date on this issue. The Committee will be aware of my previous appearance before the Committee on 18 January 2003 and this Departments previous statement to the Committee on 27 March 2003, when it met with the chief executive of GMS Payments Board and of the various Health Boards, that a substantial exercise has been under way involving the ERHA, the three Area Boards and the seven Health Boards to review the entire GMS register. This exercise has been directed by the Department and involved close co-operation with the GMS Payments Board and has been coordinated by a dedicated team led by the Health Boards Executive, which represents the chief executive officer's of the ERHA and the Health Boards. The exercise has now been completed.
When work commenced it was necessary to identify the actual cards which were considered to have generated an overpayment, and the amount of that overpayment. Detailed guidelines were agreed by all boards whereby three months from the date when eligibility ceased could be considered a reasonable period for the processing and removal of such a record from the GMS register. This is comparable to the equivalent timeframe for normal deletion of other public service benefits i.e. under the social welfare system. Accordingly, records discovered to have been on the GMS register for more than three months since eligibility ceased were therefore prioritised for indepth examination in relation to overpayment. The degree of overpayment for individual record would depend on the length of time between identification and removal, and the date when eligibility was determined to have ceased.
Deletion of recordsAll medical card records removed from the register have now been examined. At this point, a total of 80,931 records relating to clients aged more than 65 years have been removed from the GMS register. Of these, 72,495 records relate to over 70's. Based on the agreed guidelines, not all of these records would have generated an overpayment and the bulk of these records would therefore relate to normal activity i.e. removal due to death or a person moving to another Board area. Of the remainder a total of 28,156 are more than three months on the register and have generated an overpayment. The estimated overpayment arising from the removal of these cards from the register amounts to €7,540 million in relation to capitation payments, with an additional €0.754 million in respect of superannuation, a total of €8,294 million. This is the extent of the overpayment identified.
I would stress that the total deletions amounting to 80.931 records, comprise mostly what would be considered by the Health Boards to be normal deletions – due to death, change in eligibility status or persons moving from one board area to another. In calculating the overpayments relating to over-70s, it was decided to concentrate on those records which were in excess of three months out of date. It is this cohort which comprises the 28,156 over 70 records and which have generated the overpayment above. I would also point out that at the time that full medical card eligibility was extended to all over 70's, i.e. 1 July 2001, some 16,884 cards were more than three months out of date amounting to an overpayment of €6,649 million at that point in time. This constitutes the bulk of the overpayment identified as these cards would have been on the system for a longer period.
GP non-capitation allowancesBecause of the many changes to the contractual agreements with general practitioners over the period in question, the GP non-capitation allowances element of overpayments is proving more difficult to calculate. A detailed exploratory analysis by the GMS Payments Board has shown that there was an overpayment in respect of these allowances. The Board is presently attempting to quantify this amount. Analysis to date shows that it is extremely resource intensive to calculate the overpayment under this heading for individual GPs. When more complete information is available on this, a judgment will need to be made as to where the balance of advantage lies in the context of the best use of taxpayers money.
Future management of databasesDuring the course of this exercise Health Boards have dedicated substantial resources to examining and reviewing the management of their record systems. Additionally, improvements in the General Register of Births, Marriages and Deaths have assisted in the process of deleting records. As indicated previously, the ultimate solution to accurate record maintenance of the GMS register is the development of a unique client identifier. Work is ongoing on the implementation of this project, which will deal, inter alia, with the issue of data integrity and the management and control of client registration going forward. As one element of the Health Reform Programme, the absorption of the General Medical Services (Payments) Board as part of the new Health Services Executive will lead to a single consolidated database for medical cards nationally.
Recoupment of overpaymentAs previously signalled, we are committed to the recovery of excess payments, taking account of the legal and practical issues involved. Legal advice, based on existing statutory and case law, and the detail of the GMS GP contract has been obtained. That advice, including Senior Counsel opinion, has only recently come to hand. It is now being considered by the chief executive officer's of Health Boards, the GMS Payments Board and the Department. Our consideration is informed by the knowledge that any attempt at recoupment is likely to be challenged in the Courts and we acknowledge that great care needs to be taken on how to proceed from here. Any steps taken in this regard will need to be proofed against the probability of legal challenge. The IMO have already indicated that they will resist any attempt at recoupment. Subject to clarifying legal issues, the Department's intention is that full recoupment will be pursued. I will be formally notifying the IMO of this when I meet with them in the coming week.
