November 5, 2013
Deputy John Deasy asked the Minister for Health the checks he has put in place to ensure that doctors cannot overclaim for medical card patients who have died or emigrated; if his Department have a fraud control system similar to the one operated by the Department of Social Protection; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
Capitation fees are paid to General Practitioners where a person has eligibility for a Medical/GP Visit Card. Fees are not paid where eligibility no longer exists e.g. following an assessment of means, emigration or death. Under the Health Act 1970, there is an obligation on all card holders to notify the HSE of any change in their circumstances, which would put them above the Medical Card/GP Visit Card income guidelines.
In addition to the review of eligibility on expiration of a medical card, targeted reviews of eligibility were introduced during 2012, in relation to medical cards which had been inactive for more than 12 months. In such cases, medical card holders were formally contacted to confirm that they were still resident in the State. In cases where no response was received, eligibility was removed and the payment of capitation fees ceased.
In 2012, the HSE introduced data sharing with the Death Events Publication Service (DEPS) operated by the General Register Office (GRO). Death notifications are received by the HSE from the GRO on a weekly basis and payments to the GP are ceased immediately.
Where there is a delay in recording a death with the GRO, any amounts paid to GPs between the date of death and prior to the notification of the death to the HSE are recouped from the GP immediately the death information is received by the HSE.
In addition, GPs can update the database to reflect the death of patients on their GP list. In 2012, GPs made 4,400 such amendments and in all of these cases payments to the GP are ceased immediately.
Deputy Deasy asked the Minister for Health the number of reviews that were carried out on over 70s medical card applications following the budget changes introduced in 2012; if these same applicants will have to go through a further review following the 2013 budget changes; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
The Health (Alteration of Criteria for Eligibility) Act 2013 gave legislative effect to the Budget 2013 measure to reduce the gross income thresholds for an over-70s medical card and to provide for a scheme of assessment for an over- 70 s GP visit card. Following enactment, in the period from 5th April 2013 to 30th October 2013, 82,103 review application assessments have been conducted in respect of applicants and their dependents, if any, holding such eligibility.
Further changes were announced in the Budget 2014 on the gross income thresholds for an over-70s medical card. When the requisite legislation to bring these changes into effect is in place, all persons currently holding over -70s medical card eligibility will be subject to a review assessment. The purpose of these review assessments is to determine if persons will continue to hold eligibility under the revised income qualifying limits.
Deputy Deasy asked the Minister for Health if applicants for the over 70s medical card are subject to the same discretionary conditions as those under 70, whereby financial hardship as a result of medical need may be assessed; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
Medical Card and GP Visit Card eligibility under the scheme for persons aged 70 or older is solely based on an assessment of gross income.
For persons person aged 70 or older who are assessed as ineligible under the gross income thresholds that apply, they may also have their eligibility assessed under the means tested medical card scheme. This assessment is based on net income and assessable outgoing expenses and the qualifying income thresholds under this scheme are lower than over-70s gross income thresholds.
If a person is means assessed ineligible for a medical card under the general scheme and that person has other social, medical or financial circumstances relevant to an assessment of their ability to provide for their medical needs or the medical needs of any dependants they may have, these factors will be considered to decide if a medical card or GP visit card should be approved on discretionary grounds under the ‘undue hardship’ or ‘undue burden’ provision of the medical card scheme.
Deputy John Deasy asked the Minister for Health the checks he has put in place to ensure that doctors cannot overclaim for medical card patients who have died or emigrated; if his Department have a fraud control system similar to the one operated by the Department of Social Protection; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
Capitation fees are paid to General Practitioners where a person has eligibility for a Medical/GP Visit Card. Fees are not paid where eligibility no longer exists e.g. following an assessment of means, emigration or death. Under the Health Act 1970, there is an obligation on all card holders to notify the HSE of any change in their circumstances, which would put them above the Medical Card/GP Visit Card income guidelines.
In addition to the review of eligibility on expiration of a medical card, targeted reviews of eligibility were introduced during 2012, in relation to medical cards which had been inactive for more than 12 months. In such cases, medical card holders were formally contacted to confirm that they were still resident in the State. In cases where no response was received, eligibility was removed and the payment of capitation fees ceased.
In 2012, the HSE introduced data sharing with the Death Events Publication Service (DEPS) operated by the General Register Office (GRO). Death notifications are received by the HSE from the GRO on a weekly basis and payments to the GP are ceased immediately.
Where there is a delay in recording a death with the GRO, any amounts paid to GPs between the date of death and prior to the notification of the death to the HSE are recouped from the GP immediately the death information is received by the HSE.
In addition, GPs can update the database to reflect the death of patients on their GP list. In 2012, GPs made 4,400 such amendments and in all of these cases payments to the GP are ceased immediately.
Deputy Deasy asked the Minister for Health the number of reviews that were carried out on over 70s medical card applications following the budget changes introduced in 2012; if these same applicants will have to go through a further review following the 2013 budget changes; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
The Health (Alteration of Criteria for Eligibility) Act 2013 gave legislative effect to the Budget 2013 measure to reduce the gross income thresholds for an over-70s medical card and to provide for a scheme of assessment for an over- 70 s GP visit card. Following enactment, in the period from 5th April 2013 to 30th October 2013, 82,103 review application assessments have been conducted in respect of applicants and their dependents, if any, holding such eligibility.
Further changes were announced in the Budget 2014 on the gross income thresholds for an over-70s medical card. When the requisite legislation to bring these changes into effect is in place, all persons currently holding over -70s medical card eligibility will be subject to a review assessment. The purpose of these review assessments is to determine if persons will continue to hold eligibility under the revised income qualifying limits.
Deputy Deasy asked the Minister for Health if applicants for the over 70s medical card are subject to the same discretionary conditions as those under 70, whereby financial hardship as a result of medical need may be assessed; and if he will make a statement on the matter.
REPLY / Minister of State Alex White:
Medical Card and GP Visit Card eligibility under the scheme for persons aged 70 or older is solely based on an assessment of gross income.
For persons person aged 70 or older who are assessed as ineligible under the gross income thresholds that apply, they may also have their eligibility assessed under the means tested medical card scheme. This assessment is based on net income and assessable outgoing expenses and the qualifying income thresholds under this scheme are lower than over-70s gross income thresholds.
If a person is means assessed ineligible for a medical card under the general scheme and that person has other social, medical or financial circumstances relevant to an assessment of their ability to provide for their medical needs or the medical needs of any dependants they may have, these factors will be considered to decide if a medical card or GP visit card should be approved on discretionary grounds under the ‘undue hardship’ or ‘undue burden’ provision of the medical card scheme.
