Despite implementing major savings and cutbacks and getting a Government bail-out, the HSE was still able to give back €31 million to the Exchequer at the end of last year.
The health executive's annual report for 2013 states that it has a statutory requirement not to overspend on its allocation each year.
"It is almost impossible to achieve an exact breakeven position on a net vote expenditure of €12.5 billion", the report states.
The HSE recorded a surplus of €31.074 million in 2013, which was returned to the Exchequer.
The report says this is a considerable achievement for the health services in view of the very challenging environment in which it operated last year, given the increasing demand due to demographic pressures, the need to ensure patient safety and the very challenging targets for service delivery in areas such as waiting times.
The HSE says these risks were mitigated by savings in other areas last year.
The health executive received a supplementary allocation of €219 million from the Government at the end of last year.
However, the HSE end-of-year deficit prior to using the supplementary funding was €187.9 million, resulting in a surplus of €31.047 million, which was given back to the Government.
The HSE received a €360 million bail-out at the end of 2012, but it only used €337 million of this to cover its deficit at the time, and it gave the balance back to the Exchequer.
The report says the bail-out last year was to address expenditure difficulties in hospitals, non-achievement of targeted pay savings under Haddington Road, non-achievement of income targets due to a delay in legislation on private bed charges, and delays in the introduction of medical card savings targets.
The HSE, in a report to the Public Accounts Committee this week, said €148 million of the supplementary funding granted at the end of last year related to overrun issues that were outside its control.
Writing on the HSE accounts in the 2013 annual report, the Comptroller and Auditor General, Seamus McCarthy said significant proportions of medical card holders had been found, following reviews, not to be eligible for their cards.
He said the number of ineligible cardholders detected in targeted HSE reviews may be higher than that which exists in the cardholder population as a whole.
The Comptroller said the HSE does not currently have a reliable estimate of the level of ineligibility among card holders, but was examining options for developing a suitable methodology to produce such estimates.
Mr McCarthy made his comments in the report last month, a week before the Government suspended reviews of discretionary medical cards.
Health officials are appearing before the PAC today to discuss medical card reviews, top-up payments and other issues.
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