Hospitals fined for “undue charges”; didn’t previously inform of total costs
Several private hospitals have been fined by the ERS (health regulatory entity) and forced to return tens of thousands of euros to patients who were ‘unduly charged’ (not previously informed of total costs likely to be billed).
Writes Lusa today, “according to deliberations issued in the 4th quarter of last year, disclosed today, ERS concluded that Hospital da Luz, S.A. and Hospital CUF Descobertas, both in Lisbon, as well as Hospital Privado da Boa Nova (in Matosinhos) violated the right to provide users with prior information on the total amounts to be charged for health care provided, in some cases conditioning freedom of choice”.
Regarding Hospital da Luz S.A, ERS refers to dozens of cases that occurred in the Hospital da Luz -Lisbon and Hospital da Luz – Torres de Lisboa units.
It said the provider’s actions “did not prove to be suitable and effective” in terms of safeguarding the rights to information for all users who complained, to “full and unconditional discharge” in some cases and to freedom of choice in others.
Of 13 cases analysed, ERS orders the healthcare provider to review billing and return to users amounts charged, which in the cases referred to exceed €1,500.
The regulator considers that both units of the Chinese-owned Hospital da Luz S.A. also violated the duty to keep registration data up to date, namely information on agreements and conventions of which they are holders.
It warned that health care providers should refrain from presenting incomplete estimates or budgets for treatment episodes and stressed that whenever it does not seem possible to estimate the totality of the acts, exams, consumables or drugs that may be used, “users should be clearly informed of this impossibility of estimation and warned of the relevance of this in the total cost”.
In the case of agreements with the SNS, ADSE (subsidised health service for public sector workers) or other public or private health sub-systems or health insurance, ERS said providers should take “special care when transmitting information on the conditions of access of users to the health care they provide”.
“It should be ensured that, prior to the provision of health care, users are fully informed about the existence of conventions or agreements and their applicability in the specific case, especially if the proposed acts are covered by the respective coverage,” said ERS
As for CUF Descobertas, the ERS mentions the case of a user who was presented with a quote for a surgery worth €7,000 and subsequently received an invoice for payment of around €17,000.
In this case, the ERS says that the provider “put into question the rights and legitimate interests of users”, in terms of the obligations of “providing accurate, timely and transparent information” prior to the provision of health care.
In further investigation, the regulator says it has become aware of another 12 identical complaints (billing problems) and has ordered a review of the invoices in question and the return of the amounts unduly charged, which in these cases exceeded €21,000.
ERS ordered the Portuguese-owned CUF Descobertas Hospital to review and update procedures in force and make the necessary corrections. Given that some of the cases reported indicate violation of users’ freedom of choice, ERS ordered the opening of respective administrative offence proceedings.
Finally, as for the Hospital Privado da Boa Nova (part of the Portuguese Trofa Saúde group), there too was evidence that the provider’s actions “put into question the rights and legitimate interests of users” regarding the provision of “accurate, timely and transparent” information prior to the provision of health care. ERS has ordered the review and updating of procedures, making necessary corrections as well as the returning of amounts unduly charged.
Since at least one case was detected that indicates a violation of the user’s freedom of choice, an administrative offence proceeding has also been opened.
“Users should know, as accurately and as closely as possible, the total cost of the treatment and intervention proposed to them, so that they can confirm whether they have the capacity to bear these costs themselves or through any subsystem or insurance contract they may have,” stresses ERS.
LUSA
