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