Two hospitals have to provide more information on their use of National Treatment Purchase Fund waiting list funding, the Public Accounts Committee has heard.
Representatives from the Children's Health Ireland and the National Treatment Purchase Fund Board were before the Public Accounts Committee, which is examining funding.
Fiona Brady, Chief Executive of the NTPF, said two other hospitals have until tomorrow to provide further clarification on the use of the funds.
The NTPF will then prepare a report on its review of all hospitals for the Department of Health and an update for the HSE Chief Executive Bernard Gloster.
Already, three hospitals were identified as being the subject of HSE internal audits - one CHI hospital, Beaumont and the latest developments regarding Naas General Hospital.
It emerged the issue at Naas General Hospital involved the facility paying a consultant per patient, which is against the NTPF scheme.
In relation to the HSE internal audit being conducted at Naas General Hospital, the NTPF told the committee the facility was paying the consultant per patient which is against the rules of the waiting list scheme.
"We do not pay consultants directly," Ms Brady said.
Social Democrats TD Aidan Farrelly asked the NTPF how such an action could happen given the NTPF's claims to have "strong financial oversight".
In response, Ms Brady said the public body "would have no oversight of that", adding: "It was a decision that they made".
Deputy Farrelly asked if any other alleged breaches have been reported, other than the ones that the committee has been told.
Ms Brady said "nothing else" was disclosed to her apart from two hospitals that have to provide further clarification on the use of waiting list funding from the public body.
She said they have until tomorrow to respond with the information sought.
"We'll compile the report then and send it to the Department of Health," she added.
Separately, Children's Health Ireland told the PAC as part of the ongoing hip dysplasia surgery review, 2,259 families have been written to offering follow up checks over the coming months.
An expert panel is also being established to assess if the operations were necessary.
A previous review, which was published, found that many hip operations on children at Temple Street and National Cappagh Orthopaedic Hospital were not necessary.
CHI said it has not been evasive in relation to the publication of its internal audit which looked at a number of issues, including culture and the use of waiting list funds.
Its Chief Executive Lucy Nugent provided more detail about services provided under the National Treatment Purchase Fund (NTPF).
Her comments comes after an unpublished Children's Health Ireland report into concerns at one of its hospitals concluded that "a root and branch review" of use of the NTPF and other waiting list initiatives "should be undertaken".
The report, which has been seen by RTÉ News, said that a consultant who has since retired had breached guidelines by referring public patients to the doctor's own weekend clinics.
In response, CHI said in a statement the clinics did not take place in the consultant's private rooms and instead occurred in a public clinic.
Ms Nugent reiterated this at the PAC, saying "there was some misunderstanding in media reports" concerning NTPF payments "to a CHI consultant".
"The clinics at the centre of the reports did not take place in the consultant's private rooms," she said.
Ms Nugent said they happened in a public CHI hospital on a Saturday as part of a waiting list initiative for an "outpatient appointment only".
She said that a longer term sustainable solution for referral management was put in place and the roll out of this system is ongoing.
In response to a question posed by Labour TD Eoghan Kenny asking her what she thought of the Taoiseach and Tánaiste's calls for the full report to be published, Ms Nugent said: "I respect their opinion."
But she noted that she had legal advice which must be considered, as must her obligation to treat staff fairly.
She explained why an "anonymised report" would not make sense, saying the health community is very small and people could be identified.
CHI, she said, is a statutory body and must respect the legal advice it receives and the moral imperative to protect the confidentiality of patients.
Ms Nugent added CHI has a duty to see that matters are properly investigated and that due process is carried out.
This, she said, does not mean CHI is not mindful of the "great upset" that such reports cause parents and children, and the gravity of the issues.
The Comptroller and Auditor General (C&AG) said Children's Health Ireland should have brought the findings of its internal audit to the attention of its own team in the course of the 2021 examination of financial statements, the Comptroller and Auditor General (C&AG) has said.
Seamus McCarthy told the Public Accounts Committee that recently an internal examination by CHI in 2021/22 has come to public attention.
The C&AG said his office was not provided with a copy of the report at the time it was finalised, or when the audit of the hospital's financial statements for 2021 was being undertaken.
The C&AG told the committee that while the main focus of the CHI audit was on personnel management concerns in relation to a clinical department in part of the hospital, "it also raises some concerns around a number of financial risks".
He said these include the controls over claims in respect of care paid for from the National Treatment Purchase Fund.
Mr McCarthy said his office has received the report in recent weeks.
CHI declined to publish the report citing legal advice and has published its summary of the audit.
Mr McCarthy said that in 2023, CHI had a total income and expenditure of over €190 million, which has grown rapidly in recent years.
The NTPF secures treatment and assessments for waiting list patients in private hospitals, and in public hospitals, which offer spare capacity to provide patient care
In 2023, it paid private hospitals €107m and public hospitals €72 - representing 60% reliance on private healthcare providers and 40% reliance on public healthcare providers.
