Astronomical debts owed to two Galway hospitals by patients who failed to pay for their care, HSE audit finds

The HSE internal audit into University Hospital Galway and Merlin Park University Hospital also found hospital consultants had not sent invoices worth up to €12.2m to private health insurers for payment for insured patients.

The consultants should send the claims within 15 days of the patient’s discharge to ensure the public ­hospital is repaid and benefits from the cashflow. However, the delays ranged from 30 days to six years in some cases.

The auditors who carried out the inspection last February found the consultants still had to send off 3,903 claims to health insurance companies.

The patient fees would have covered the emergency department charge, as well as the €80-a-night public inpatient fee, which was abolished in April, along with income payments due from insurance companies for treating road accident injuries.

The hospitals, which are part of the Saolta group, have told the auditors that recommendations to review and enhance controls will be followed.

A patient debt should be paid within 30 days and if not, a reminder should to be issued. After eight weeks, the ­matter can be referred to a debt collector.

The auditors found that the patient accounts department had a procedure for debt collection but it did not ­specify timelines.

The audit report said that as of ­December 2022, there was provision for bad debts of €30m and the net patient balance was €15m.

The auditors also found that there was no information leaflet provided to patients who need inpatient care to clarify if they had health insurance.

This would outline the benefit of being treated privately and generate income for the hospital.

There were no patient liaison officers to follow up incomplete private health insurance forms. It means patients who have private cover are slipping through and their insurer is not obliged to pay for their care.

The auditors said attendance figures for 2022 showed 44,052 admissions of patients as inpatients. It raised €33m in patient charges and received €23.6m.

Some €4.6m was recorded as “struck off” during that year, of which €3.6m was raised in error.

A separate audit involved site visits to Sligo University Hospital, Mercy University Hospital and Letterkenny University Hospital to observe ambulance turnaround times and how soon they are free after bringing a patient to the emergency department..

The target is 20 minutes but this was not achieved in nearly half of the cases.

An observation of ambulance handover times over a four-hour period at the three emergency departments found that the reasons for the delays all related to emergency department demand and no space, with lack of a free chair, trolley or bed on which to place the patient.