Health insurance companies owed the Health Service Executive €290m for private patient income at the end of 2014, according to the latest figures from the Comptroller and Auditor General.

The wide-ranging report reveals serious issues in financial management across the public sector, resulting in additional burdens on the taxpayer. 

The money owned by health insurance companies comprised €172m relating to statutory hospitals and €118m for voluntary hospitals.

Private income rose after the HSE introduced new systems in 2014, permitting all private patients to be charged regardless of whether they were treated in a private bed, public bed, a trolley or on a chair.

As that clarification did not arise until mid 2014, additional charges totalling €25.7m had to be levied.

However, the HSE was unable to say how many of those invoices had actually been generated.

The C&AG also notes that while the pace of debt collection had improved in 2012 to 134 "debtor days", it is taking longer to generate invoices and collect debts due from private health insurance companies.

It now takes an average of 186 days to collect a private insurance claim - 212 days for HSE statutory hospitals and 158 days for voluntary hospitals.

The C&AG notes that this means that the exchequer is funding the gap in hospital revenue due to the late payment of private health insurance claims.

In addition, the proportion of claims queried by private insurance companies rose by 69% in 2014.

The CAG also criticised hospitals' implementation of a new claims processing system called Claimsure, which facilitates fully electronic claims processing and submission.

So far 44 hospitals are using Claimsure, but only 29 have fully integrated it.

This means that in others, a high level of "manual intervention" is required.

For example, submission of a claim may involve printing an invoice which is then scanned to the insurance companies together with other supporting documentation.

The HSE acknowledged the difficulties, but said that the new system is better than what was there previously.

Outstanding issues including data governance are under negotiation with the insurance companies and a pilot project is under way.

Cost of Eircode estimated at  €38m

The C&AG report has found the estimated cost of the Eircode project will be around €38m.

The figure includes a cost of €686,000, relating to changes to the licence holder contract subsequent to the contract being signed. 

An outreach campaign to assist those considered to be vunerable and hard to reach has so far cost €527,000. The licence holder did not go to tender in relation to this campaign. 

The Government was also forced to pay over €340,000 in compensation as a result of a delay in launching the project. 

An indicative launch date of the end of May 2015 had been agreed with the licence holder, however due to delays mainly associated with the introduction of data protection legislation, a revised date of 6 July was agreed and Eircode was launched on 13 July.

The licence holder sought €1.2m compensation in respect of additional costs and revenue foregone from the change in launch date. 

The C&AG has said it is not clear that the €38m scheme will achieve the data-matching benefits the Government had hoped. 

State lost €48m on Thornton Hall site purchase

The purchase of the Thornton Hall site for a prison resulted in a loss of €48m to the State.

The site was purchased in 2005 but so far no prison building work has been undertaken and the site is currently being used as a prison horticulture project.

€50.6m had been spent on the Thornton Hall project by May.

The State paid €29.9m for the site, but a valuation report in February put the value of the land at €2.4m.

It was envisaged that Thornton Hall would replace the four prisons on the Mountjoy prison campus, but in light of the delays in progressing the project, €28.7m has been spent between 2010-2014 on capital works at Mountjoy.

The C&AG report has concluded that the Government was advised that €150m would be the cost for a new prison, but since 2010 many of problems at Mountjoy have been dealt with at a much lower cost.

Private hospital charge delays causing problems for HSE

The C&AG report found that changes to the charges for private hospitals have brought increased income for the Health Service Executive.

The new charges came into effect on 1 January last year and cut the fees applied for many services but more patients became liable for charges .

There was net increase in patient income for the HSE of €66.2m for 2014.

But the report also found that the confusion over the new charges resulted in delays collecting the income from health insurance companies and the HSE has had to meet the funding gap caused by this.

The C&AG recommends that in the future when new charging regimes are introduced all stakeholders - the Department of Health, the HSE, hospitals and the insurance companies - should be engaged as early as possible to avoid delays.

The report also found that consultants are not meeting agreed targets on signing off on claims for payment.

The average numbers of days it is taking consultants to sign off is 58 days - 68 in statutory hospitals and 47 in voluntary hospitals.

This is well in excess of the 20 days agreed at the Labour Relations Commission in September 2012, and the revised temporary target of 30 calendar days adopted by the HSE in November 2013.

€1.5m a week overpaid in illness benefits in 2014

A review by the Department of Social and Family Affairs has estimated that €1.5m a week was overpaid to people on illness benefit in 2014.

A similar review of payments to those on an invalidity pension estimates overpayments of €348,000 a week were made last year.

As medical ineligibility was a factor in some of these overpayments, the Comptroller and Auditor General has recommended that the department examines the current controls it uses to decide when medical reviews of those on benefits should take place.

The Department of Social Protection said it is finding it difficult to retain and recruit medical controllers but more are being hired this year and next. It added that it is working with medical professionals to highlight the rules around medical eligibility.

€11m tax settlement made by SEC in 2014

A tax settlement of almost €11m was made by the State Examinations Commission last year, as a result of an audit of expenses paid to contract staff.

The audit relates to differences in interpretation of how payments to certain categories of staff engaged by the SEC for running the Junior and Leaving Certificate exams should be treated.

Around 23,000 contract staff are used every year with the majority drawn from Ireland’s second-level teachers.

€10.9m was spent on home tuition last year, with around 1,200 tutors engaged in the provision of home tuition and €7m being paid to home tutors and the balance to specialist providers.

The Department of Education provides funding for home tuition under a number of schemes.

A Revenue audit found that all payments for one-to-one tuition are liable for deduction of taxes at source which was not happening.

Failure to register for water charges

On the controversial water charges, as of 31 August 2014, almost  1.1 million households had registered for the charges. However, almost 425,000 households had failed to register.

National Lottery contribution falls short

The National Lottery was due to contribute €200m to good causes but it only handed over €178m in 2014 due to transitional costs in moving to a new regime.