Claim ACC ignoring surgical costs

The public health system should be clawing back all of the money it spends on surgery performed on patients whose claims are later accepted by ACC, Dunedin ACC lawyer Peter Sara says.

Mr Sara felt so strongly about it he considered standing for election recently to the Southern District Health Board.

''I cannot understand why the [board] has not insisted on this kind of costs recovery. The excuse that there is no protocol is, frankly, pathetic,'' he said.

The issue was especially pertinent because the public health service was being cut, while ACC posted large surpluses, he said.

Some cases fell outside ACC's contractual agreements with boards, where the corporation had not accepted the claims were genuine.

Mr Sara wrote to the Otago Daily Times in October, asking if the Southern District Health Board recovered costs in cases such as a review he won, where a hernia operation had already been performed by the public system, but the ACC was later found liable.

In response, health board chief executive Carole Heatly said the issue was confidential.

The ODT sought answers under the Official Information Act, and after two months was told there was no formal mechanism by which the board was alerted to such cases.

However, the board recovered costs when it could, patient services director Lexie O'Shea said.

''In some cases, where we are informed that a case has been accepted on appeal, we do invoice.''

Since mid-2010 the board had invoiced ACC for six cases that had been declined ''at some point of the process'', but the point at which ACC had accepted the six claims was not clear.

A spokeswoman for ACC said such cases were ''rare, and generally ACC is not aware that surgery has taken place''.

ACC received 58,706 requests for elective surgery in 2012-13, and of those 10,047 were declined, although it was unknown how many were accepted subsequently on appeal.

Mr Sara said the situation was ''appalling'', and such instances were certainly not rare.

ACC simply turned a ''blind eye'', reducing its costs, he said.

''The taxpayer ultimately is forced to carry the burden of this statutory insurer ... There's no incentive for [ACC] to find out [about the cases]. I was so cross about this I was tempted to run for the health board this year, but my wife interceded.''

In its latest annual report, private insurer Southern Cross Health Society said it recovered about $3.8 million from ACC and helped 394 members through case reviews in 2012-13.

Southern Cross chief executive Peter Tynan said in the report: ''We assist in this way not only to ensure our members' accident and injury-related treatment costs are met by the right organisation, but also because they may have additional entitlements under their ACC cover, such as earnings compensation, rehabilitation and home help.''

eileen.goodwin@odt.co.nz

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