Public hospitals lost millions over unpaid private bills

Public hospitals are losing millions of euro a year due to unpaid bills from private health insurers, new figures reveal.

Over the last four years across HSE-run and voluntary hospitals, €125 million has been written off in private insurance claims.

In that time, €37.6 million has been lost as a result of the HSE not properly submitting claims to insurers.

Public hospitals routinely earn millions from fee-paying patients.

However, procedures for private patients are seemingly carried out free of charge in the public system on a routine basis due to unpaid bills submitted to health insurers.

This means the taxpayer rather than the insurer is footing the bill for treatments and comes with several hospitals under financial strain.

The HSE is also heading towards a €1 billion budget overrun this year.

Health insurers can decline to pay bills for several reasons, including situations in which invoices were not submitted by the required date, where doctors or patients did not sign the claim form or where the patient concerned did not have the appropriate cover.

According to a detailed breakdown provided to the Dáil's Public Accounts Committee, €23.9m was written off in private insurer claims in 2022, €24.5m in 2023, €37.2m in 2024 and €39.5m in 2025.

Committee Chair John Brady described the figures as "extremely concerning", an "incredible failure" and "absolutely scandalous".

He added: "Incredibly, it is explicitly stated that €37.6 million of this sum was written off because claims were not properly submitted by the HSE.

"€37.6 million lost because the relevant paperwork and process was not completed."

In a briefing note to the committee, the HSE's Acting Chief Finance Officer Michael Lane explained that "where a patient elects to be treated privately, hospitals will submit an insurance claim for the length of stay at the appropriate daily accommodation rate as outlined in legislation.

"All claims not paid by insurers are followed up by the hospital to determine the reason for non-payment and where the hospital considers that the reason is not valid, it will fully pursue payment with the relevant insurer.

"Claims are written off only once this process is complete."

He said write offs typically relate to debt in excess of one year old.

Of the €37.6 million lost due to the HSE not properly submitting claims to insurers, €23.3m was not submitted within the timelines set out in the VHI memorandum of understanding, while €5.9m of claims had become statute barred.

The HSE has a memorandum of understanding with the VHI for the treatment of its subscribers.

Under the arrangement, the VHI prepays a percentage of the hospital's component of all claims upfront pending the claim being submitted.

The claim then needs to be submitted within one year.

Mr Lane said the €125m written off between 2022 and 2025 should be considered in the context of the €1.55 billion collected from private insurers by the public system in the same period.

Of the €125m written off, €71.9m was deemed to be "correctly rejected by insurance providers", while €13.8m was disputed by the HSE.

St James's Hospital lost the most in uncollected revenue from health insurers over the last four years.

It wrote off €13.3m and this included €6.1m in 2025 alone.

Tallaght Hospital recorded invoices to the value of €12.6m not paid by health insurers since 2022.

University Hospital Limerick wrote off €11.5m, including €9.2m because claims were not properly submitted by the HSE.

Galway University Hospitals lost €9.88m in the same period, including €5.346m in 2025.

St Vincent's University Hospital lost revenue of €8.65m in private insurer claims written off from 2022 - 2025, including €6.4m in 2025.

This is compared to €286,000 in 2024.

Deputy Brady is calling for greater transparency on how the money was lost as well as a "radical overhaul" on how claims are processed.

"We need to know who is responsible for these failures, and what penalty or sanctions are being imposed," he said.

He added: "This is public money that should be going back into our health service, yet tens of millions of euro is being lost because the most basic administrative tasks are not being carried out properly.

"It should not be lost that this is happening at a time when much focus is being placed on massive overspends across the health system."