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The HSE has been investigating whether an orthodontist allegedly claimed to have carried out some treatments in Northern Ireland when this was not the case.
The Executive said it was conducting probity checks “in relation to” claims for reimbursement under the CBD. It said it does not comment on individual cases.
Asked why an award was made when its investigation was continuing, the HSE answered that its checks were “ongoing”.
The CBD allows patients to access care elsewhere in the EU and claim for reimbursement by submitting relevant documentation, such as invoices.
The HSE did not disclose how many “healthcare providers” it is investigating, the amounts funded or where/why reimbursement was withheld.
“For reasons of the ongoing checks, it is not possible to provide detailed information at this point in time,” a HSE spokesperson told MI.
A letter from a healthcare provider to a patient’s family refused reimbursement under the CBD, seen by MI, stated that, as had been discussed in clinics inside and outside the Republic prior to commencing treatment, they were unable to guarantee eligibility for the “HSE grant”. This was “made clear” verbally and in written material prior to commencement of treatment.
The letter noted that the claim is not submitted to the HSE by the healthcare provider and any grant awarded is “paid directly to the patient”.
The healthcare provider wrote that “you appeared to be perturbed by the thought” that the HSE was investigating any patient or provider that claimed a grant through the CBD. This was “normal protocol” for patients claiming funding from the HSE, they wrote.
A source close to the patient who received the disputed treatment said the assessment and payment of the overall fee took place outside the Republic. However, treatment allegedly continued in the Republic. They allegedly understood from the healthcare provider that this was permitted under the CBD.
The source expressed upset at an accusation from the HSE that they had falsified information. This source is now considering what further action they could take on the matter.
Emergency treatment can be obtained in the public healthcare system in Ireland where a patient is availing of healthcare abroad under the CBD. Urgent treatment is not applicable.