An action by the Health Service Executive 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.

The dispute is over interpretation of certain sections of the 1970 Health Act, with the HSE claiming that Laya’s actions have caused it to suffer a loss of more than €20 million.

The HSE maintains that once a private patient being treated in a public hospital opts to receive private care, the patient or insurer becomes liable for the payment of charges incurred for the time they spend in the public hospital.

The HSE claims Laya’s position is that private patients are to be treated at public patient rates until the patient signs a private insurance patient (PIP) form, electing to be treated as a private patient.

Public vs private

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

The HSE claims Laya’s interpretation means 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.

Laya’s position is not supported by the relevant provisions of the Health Act, the HSE says.

The HSE maintains 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.