A HSE internal audit has found that €2m was paid to hospital consultants to reduce waiting lists at Naas General Hospital (NGH) outside of public pay policy guidelines.
The payments were made over four years from 2022 to 2025.
The audit found that the National Treatment Purchase Fund (NTPF) funded payments to NGH of €1.5m which was paid directly to consultants, and a further €473,320 to two companies, the directors of which are Tallaght University Hospital (TUH) consultants.
The audit, which was completed in November 2025, but released under FOI to Prime Time, found that payments to consultants from Naas and Tallaght were made on a paid on a "fee per patient" basis via their hospital payroll systems.
While Naas consultants were paid on a per patient basis via NGH hospital payroll, TUH payroll paid their consultants "indirectly by converting per patient fees into overtime hours".
TUH then recouped the cost from NGH for those payments.
The cost of paying consultants on per patient basis was compared in the audit with payments for consultations done within ordinary hospital work schedules. It found hospital consultants were paid at "significantly higher levels under the fee per patient structure that they would have been through standard contractual or overtime arrangements".
It concluded that this represents "an inefficient use of public funds" and may "incentivise activity to shift away from core hours" and outside normal pay rates, thereby presenting "governance risks".
No procurement processes or controls
The audit found that the hospital used NTPF funds to manage its performance in relation to "high-demand specialities such a dermatology, respiratory and endoscopy services".
However, for third party companies it employed there was "no record of a competitive tender process being undertaken by the consultant companies providing clinics/consults".
There was also "no evidence of approval being sought by hospital management for a derogation from standard public procurement procedures", the audit says.
A crucial part of the NTPF funding of insourcing to reduce waiting lists is maximise the use of the public hospital facilities and reimburse the hospital for the extra costs involved in treating patients out of normal hospital hours.
Yet the audit reports that the CEO Naas General Hospital "cannot confirm with certainty" that all the specially NTPF funded consultations to reduce waiting lists "were strictly scheduled outside of core funded activity", i.e. ordinary public hospital clinic times.
There was also "no established processes or controls" at NGH to ensure that the amounts invoiced to the NPTF were actually paid by it, "potentially leading to a loss of revenue" to the hospital.
No Memorandums of Understanding with NTPF
The HSE internal audit also found that €8m was paid for initiatives to reduce waiting lists - insourcing and outsourcing - to Naas General Hospital over 3 years to 2024 by the NPTF despite there being no Memorandums of Agreement outlining the hospital's responsibilities and the expectations of the funding body.
A Memorandum of Understanding (MOU) was later signed in June 2025 with all funds for last year withheld pending the completion of the HSE audit. The full amount the NTPF is due to reimburse the hospital is €10.2m.
The HSE audit made a series of recommendations including that the hospital ensure all future payments to consultants are "in line with public pay policy as per NTPF rules".
It also recommended that the hospital "ensure all NTPF initiatives are scheduled strictly outside of core activity."
It stated also that "management should strengthen controls to ensure that the tendering process for all external providers is subject to a documented and transparent competitive procurement process."
In a statement, Nass General Hospital and the HSE Dublin and Midlands Health Region said they acknowledge the findings of the HSE Internal Audit review.
They said that the report’s recommendations have been accepted and "significant work" to implement them is taking place.
"This includes strengthening governance, ensuring alignment with public pay policy, and enhancing oversight and financial reconciliation processes in relation to NTPF-funded initiatives", they added.
Naas General Hospital said it will continue to work with the HSE and the National Treatment Purchase Fund to ensure that "all future activity is fully compliant with national policy and governance requirements".
