Estimates being used by Health Minister James Reilly to target savings from his planned cull of medical cards could be flawed, it has emerged.
However, results from a recent review carried out on medical card eligibility by the Comptroller and Auditor General (C&AG) also indicate that at least 8% of cards could be under threat in any future major review. The C&AG review identified weaknesses in the HSE's monitoring system for medical card eligibility.
Health Minister James Reilly's planned 'probity review' of the granting of medical cards has caused public concern, with fears that many vulnerable people who currently have medical cards will lose them as a result of the cull.
Fianna Fail has preducted that at least 100,000 people could lose their cards, and the Minister has been criticised for the lack of detail being provided to the public about the planned medical card review.
Dr Reilly, in an interview on Newstalk yesterday, indicated that a report by outside consultants PWC had assessed that savings of between €60 and €200 million could be made in a medical card probity review, and his €113 million targeted savings figure was based on that.
However, the Comptroller and Auditor General, in a report on the HSE's accounts published last month, said the PWC assessment was limited in scope as it was conducted on a review of reports rather than a detailed analysis of the medical card database and expenditure.
The PWC report estimated that the potential financial exposure arising from 'ineligible beneficiaries' of medical cards would be between €65 million and €210 million.
The C&AG said the PWC report itself, published in 2012, concluded that a more reliable estimate of potential excess expenditure on people who currently have medical cards but may be ineligible would involve a detailed review of the database of the HSE's Primary Care Reimbursement Service (PCRS), which runs the medical card scheme.
The Comptroller's report states that following the PWC assessment, the HSE employed another firm, Accenture, to conduct a review of medical card spending.
"The review did not develop a baseline estimate of the level of excess expenditure under the medical card scheme," according to the Comptroller.
The C&AG said an estimate of the overall level of excess payments for ineligible medical cards could be arrived at from analysis by the HSE of current eligibility through a random sample of cardholders, carried out on an annual basis.
The Comptroller, as part of its review of the HSE's finances, conducted a review of a sample of 50 medical card holders given cards in 2012 to see if they satisfied the income criteria for eligibility.
It was found that 'over 90%' of the cases examined had appropriate evidence of means, and had been correctly awarded the cards on an income basis in line with the provisions of the scheme.
However, it was found that in four cases (8% of the sample), the review identified 'weaknesses' in terms of granting medical cards.
In two of these cases, the evidence suggested that the card had been approved in error. In these cases, a payslip provided by the applicant had not been used in assessing income and the monthly earnings of the applicant had been calculated incorrectly.
In the two other cases, no documentary evidence had been provided for rental outgoings as deductions in calculating income, and spending for home improvement repayments had been allowed without clear evidence of the purpose of the loan.
The C&AG also found that in three of the 50 cases examined, 'discretionary' medical cards, not based on income but on medical need, had been granted.
It was found that GP reports were accepted as the main form of evidence for the applicants' medical needs, but these reports did not always specify the number of GP visits needed by the applicant or the cost and frequency of medication involved.
The C&AG also examined a sample of 25 discretionary cards awarded by the HSE, and found that in the vast majority of cases, they were awarded on the basis of significant spending by the applicant on medical costs.
The report also shows that in a recent review of 365,000 cardholders carried out by the HSE where their card was about to expire, just over 94% of those reviewed had their eligibility for a card confirmed or upgraded from a GP visit card to a full medical card.
In this review, where eligibility was confirmed by cardholder self-assessment, 98% of cards were renewed, while there was an 85% renewal rate where the HSE itself reviewed eligibility.
Overall, in this review, 4% of cardholders were found not to have eligibility for a card.
The report also shows that 15,515 people had their medical card eligibility removed last year following a review of cards where people who had not accessed medical services for a year or more and were asked to confirm their residence.
Nearly two-thirds of cardholders in this review confirmed their residence and kept their cards, with the remainder losing their cards after not replying to the review. The majority of these people had not reapplied or been granted a card as of May of this year.
The C&AG report recommended that the HSE review its controls on medical card approval, and provide more specific guidelines to staff in the approval process, and conduct more internal reviews of approvals. It also called on the HSE to tighten up controls on self-assessment of eligibility through reviews of sample cases.
The report said there was a 'significant level' of excess spending medical cards in the system, mainly resulting from changes in the cardholders's circumstances while they have a medical card.
It says the HSE has not developed an estimate of the level of excess payment in the medical card system.
The HSE, in response, said it was acting on the C&AG recommendations.
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