❓ Mr. Cook inquires about incorrect private health insurance claims in WA public hospitals during 2012-2013. The Department of Health reports 98 refunds totaling $196,038, primarily due to errors from private health funds, and outlines measures to prevent future errors.
AnsweredQoN 1669Legislative Assembly
QuestionView source ↗
(1) How many refunds were issued by the Department of Health, and/or the Health Corporate Network and/or public hospitals in Western Australia to private health insurance companies for incorrect claims of patients being treated as private patients in a public hospital in the past financial year 2012-2013? (2) What was the average amount refunded per incorrect claim? (3) What was the total amount (dollar value) of incorrect claims during 2012-2013? (4) What processes and/or procedures are in place to ensure incorrect claims are not made? (5) Have any incorrect claims been investigated by the WA Police Fraud Squad as examples of fraud? (6) How many (if any) incorrect claims have resulted in charges being laid and/or prosecutions?
AnswerView source ↗
Answered
18 March 2014
Responded by
Minister for Health
Response time
28 days
(1) 98.
(2) $2,000.
(3) $196,038 of which:
· $172,232 was due to clerical errors originating at the private health fund.
· $14,332 was a result of the patient changing their private patient status.
· $9,474 refunded due to incorrect information and/or clerical errors at the Department of Health (DOH).
(4) The DOH takes reasonable steps to ensure that private patient details are correctly recorded in the DOH's patient information and billing systems. Measures include:
· Verifying patient identity.
· Checking private health insurance membership details.
· Obtaining and retaining evidence of patient's admission and discharge.
· Obtaining and retaining evidence of patient's treating practitioner.
· Obtaining and retaining evidence of patient's diagnosis and treatment.
(5) No.
(6) Nil.
(2) $2,000.
(3) $196,038 of which:
· $172,232 was due to clerical errors originating at the private health fund.
· $14,332 was a result of the patient changing their private patient status.
· $9,474 refunded due to incorrect information and/or clerical errors at the Department of Health (DOH).
(4) The DOH takes reasonable steps to ensure that private patient details are correctly recorded in the DOH's patient information and billing systems. Measures include:
· Verifying patient identity.
· Checking private health insurance membership details.
· Obtaining and retaining evidence of patient's admission and discharge.
· Obtaining and retaining evidence of patient's treating practitioner.
· Obtaining and retaining evidence of patient's diagnosis and treatment.
(5) No.
(6) Nil.
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