VHI recoups €7 million after wrong billing

[Posted: Wed 18/04/2012 by Niall Hunter, Editor www.irishhealth.com]

Nearly €7 million was recouped by the VHI last year following investigation of claims from hospitals and consultants that turned out to be 'inaccurate or inappropriate'.

The VHI said its Special Claims Investigation Unit (SIU) saved over €6.9 million under this heading last year, and this represented a significant increase in the total recouped from wrong claims in previous years.

A VHI spokeswoman told irishhealth.com that in most cases, overcharging or inappropriate charging will have been down to simple error, but if a pattern of inappropriate charging is suspected it will be investigated.

The money was recouped following a billing audit by the SIU as well as an initiative which queried the appropriateness of claims for patients with prolonged hospital admissions, the VHI said.

It said there were 2,000 contacts from vigilant customers who queried their claims assessment statements.

Where overcharging occurs, hospitals and other providers are asked to ensure that their processes are changed to prevent any reoccurrence of overcharging.

The VHI said in some cases the money would already have been paid out to a propvider, in which case the excess charges would be deducted from future payments.

It says if there are a number of queries or repeat occurrences or anomalies with a particular hospital or service provider, an audit is conducted to identify the extent of the practice.

The VHI spokeswoman told irishhealth.com that it did not have a breakdown as the proportions of the €6.9 million figure that were made up of hospital and consultant overcharging.

She said examples of wrong charging would include a hospital billing for a patient's stay in a private room when they were in a semi-private bed, or a consultant billing for a procedure or test which was not actually carried out.

The VHI said the €6.9 million was reinvested in healthcare provision for customers. It stressed that it was a relaltively small component of the €1.3 billion paid out in claims last year.

It has asked customers to check their statements from consultants and hospitals outlining what the insurer is being charged for their treatment, and to contact VHI if they think there has been an error or an anomaly.