HEART BEAT: It was a dark rainy morning in Dublin as the task force assembled. The team leader tersely gave instructions and outlined the procedure to be followed.
The building had been thoroughly staked out and the movements of its occupants noted.
Surveillance was complete and now the building was covered front and back with all potential escape routes sealed. The leader left his team in no doubt about the importance of the mission and outlined the risks they took.
"There are some pretty desperate people in there," he said. They stealthily approached the building in ones and twos, utilising whatever cover was to hand. "Go!" the leader shouted and they crashed into the building. "Everybody freeze, down on the floor and keep your hands where we can see them."
Surprise was complete and after a brief search, the crestfallen suspects were herded together, while the team perused a veritable treasure trove of compromising documents. Another conspiracy against the citizenry had been smashed by their selfless dedication.
Meanwhile out in greater Dublin life went on as normal, unaware of the drama being enacted in Fitzwilliam Place. Life as normal meant a security van hold up, assorted armed robberies, and an occasional murder. It was just an ordinary day.
No I haven't lost my mind. I just got carried away by my imagination. Last week I noted a headline in this paper, "Price fixing investigators and gardaí raid offices of IMO".
In the report it stated that Competition Authority staff and gardaí seconded to the authority had raided the Dublin offices of the IMO; the main representative body for doctors in Ireland. No surprises here, you always knew the doctors were up to no good. What was it this time? Drug smuggling on an unprecedented scale? Were they involved in vice rings and white slavery? Horror of horrors could they have been forgetting to wash their hands when dealing with patients? They are a desperate lot and capable of anything.
Sadly, none of the above, it was more prosaic than that. They had been under suspicion for "possible breaches of competition law". This had apparently something to do with the fees paid by life insurance and financial companies for medical reports on clients.
It would have appeared to me, and possibly also to the IMO and the relevant companies, that it was eminently sensible to have an agreed set of fees for such reports. Maybe negotiations did take place to decide what was acceptable to both sides. So what? Unions negotiate rates on behalf of their members with their employers. Is this not what collective bargaining is all about?
Please don't tell me that the patient is excluded from such negotiations. Just try to imagine the chaos that would ensue if the patient traipsed from doctor to doctor seeking a lower fee for such a report. Imagine each successive doctor looking for the patient notes, formulating a report and then sending same onwards. Does anybody seriously think that appreciable savings could or would be made?
This is not the first time such melodramatic raids have been staged on professional organisations. The Irish Hospital Consultants Association (IHCA) had such a visitation regarding fixing of consultant fees with the insurers VHI and BUPA. The Irish Dental Association was also raided. Apparently for some extraordinary reason, according to the warrant they were engaged in buying and selling cars. Mind you I often wondered how dentists afforded such big cars.
As a consultant I went through all the phase of patient billing in the private sector. The sole medical insurer at the time, the VHI provided a level of fee cover to the insured that to my mind and that of the vast majority of my colleagues, was simply derisory. Thence came balance billing. The VHI paid an allowance to the patient and you billed for the balance of the fee. On rare occasions the insured person paid you neither the VHI subvention nor the balance of the bill! Such is life.
In cardiac surgery we were paid approximately one fifth of the amount our colleagues in Belfast were paid by BUPA for the same operation. I pointed this out to the then chief executive of the VHI who said; "Ah but there are five times more people insured down here." I gathered from this that we were expected to work five times harder in Dublin to have an equivalent private income.
In any case a fee schedule was agreed between the insurers and the doctors. This would guarantee the subscriber (patient) cover and free them from meeting the balance of the charge. It would give a more realistic fee to the doctor (albeit still much less than in the UK), and it would allow the insurers to claim that they provided total cover. There was no compulsion.
A large majority of the doctors accepted it, some did not. These were free to carry on as before, balance billing and all. Historically all of this is well documented and I am sure that all the relevant organisations would have little problem in making such documents available if required.
We hardly need Elliot Ness and his merry men banging down the doors as if there was some criminal conspiracy afoot. I would suggest that the gardaí and the other people involved could find some better use for their time.
Dr Maurice Neligan is a cardiac surgeon