HSE sues Laya Healthcare over payment of charges for treating private patients in public hospitals

Aodhan O'Faolain

Reporter:

Aodhan O'Faolain

The matter was admitted by Mr Justice Robert Haughton to the fast track Commercial Court list on Monday

The matter was admitted by Mr Justice Robert Haughton to the fast track Commercial Court list on Monday

AN action by the HSE against Laya Healthcare over the payment of charges for the treatment of private patients in public hospitals has been admitted to the fast track Commercial Court list.  

The dispute arises out of the HSE’s interpretation of certain sections of the 1970 Health Act that once a private patient is being treated in a public hospital opts to receive private care then the patient or insurer becomes liable for the payment of charges incurred for the time they spend in the public hospital. 

The HSE claims that the insurer has adopted a position where it believes private patients are to be treated at public patient rates until the patient signs a document called a Private Insurance Patient (PIP) form, electing to be treated as a private patient.

PIP forms were introduced in 2014 for the purpose of making privately insured patients aware of their entitlements before deciding whether or not to waive their rights to be treated as a public patient. 

Cork-based Laya Healthcare Ltd, has allegedly taken a view that only charges arising after such a form is signed are payable by it. 

That interpretation, the HSE claims, means that patients can be billed as both private and public patients during the same stay in a public hospital depending on the timing of their decision to be treated as a private patient.  

The HSE says that Laya's position is not supported by the relevant provisions of the 1970 Health Act and that Laya's actions have caused it to suffer a €20m loss.

The HSE says its interpretation of the legislation allows it to charge patients as private patients where there is an election to be treated as a private patient for the entirety of their stay in a hospital. 

The HSE also claims Laya has wrongfully asserted a right to recover money allegedly overpaid to it between 2014 and 2016.

In its action, the HSE seeks various orders and declarations from the court including a declaration that under the relevant provisions of the 1970 Act Laya is liable to pay the prevailing statutory rate for inpatient care provided at public hospitals to patients it insures during the period January 1st 2014 to date,  

A declaration that should any patient insured by Laya elect at any point during their public hospital stay opt to be treated privately is liable for the payment of the prevailing inpatient charges in respect of care provided during the entire duration of their stay is also sought by the HSE. 

The HSE also seeks, if necessary, orders requiring Laya to repay all illegal deductions made from payments due to public hospitals. 

It further seeks an account of all sums its claims are wrongfully held by Laya.

On the consent of both parties, the matter was admitted by Mr Justice Robert Haughton to the fast track Commercial Court list on Monday. 

The Judge adjourned the matter to a date in the New Year.