Numerous examples of poor financial management in the health system have been listed by the Brennan Commission on value for money in the health service.
The report describes the extension of the medical cards to the over 70's was a "classic example" of inadequate management. The bill for the extension of the scheme - which now covers about 80,000 older people rather than the projected 39,000 - is "a multiple of the original costs envisaged which continue to rise", the report says.
The commission also points to the 2001 pay deal for childcare workers which it says cost €11.4 million compared to an original estimate of €4.7 million. On the General Medical Scheme, the commission members state: "It appears to us that lessons are not being learned."
They label the 5.2 per cent estimated increase in costs for 2003 as not a credible estimate "on even the simplest trend analysis".
"The starkest example of absence of control under the heading of 'inadequate records' arises in the GMS scheme" the report says.
It highlights payments made to pharmacists without supporting evidence of the claim and people continuing to receive medical care after their eligibility for a medical card had expired.
Unauthorised expenditure is also highlighted by the commission's analysis. In 2001/2002, the report says "health board management spent €115 million on capital projects that had not been authorised by the Department of Health".
During the same period, health boards undertook €35 million of unapproved expenditure on approved projects.
The Brennan Commission says "there is evidence that ceilings on employment numbers are being breached frequently". It cites 2001 as an example, when 3,800 people over the approved employment ceiling worked in the health system.
Prof Brennan and her colleagues also found that tests relating to the private activity of consultants in the public health system were sometimes not charged for. They cite one case where a failure by consultants to provide information about their private patients to hospital management resulted in more than €1 million not being billed to private health insurers.
The report says, "it is possible fraud may occur" in the €8.2 billion annual budget of the health service.
It wants the health board CEO's to submit a written fraud policy statement to the Secretary General of the Department of Health "within six months of publication of this report" .
The commission said the use of supplementary estimates in the health service undermines budgetary discipline.