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• December 2011 - Failure to Refund Illegal Nursing Home Charges: Complaint against HSE and the Appeals Officer, Health Repayments Scheme

December 2011 - Failure to Refund Illegal Nursing Home Charges: Complaint against HSE and the Appeals Officer, Health Repayments Scheme

Investigation Report

Office of the Ombudsman
December 2011

In order to protect the identity of the family in this case, all names have been changed

Executive Summary

  Downloadable version (pdf, 296 kb)

1.0 - The Complaint

2.0 The Health Repayment Scheme

3.0 The Circumstances of this Case

4.0 This Investigation

5.0 The NAHB and the Nursing Home – Contracted Bed or Private Arrangement? - The Evidence

The NAHB and the Nursing Home – Contracted Bed or Private Arrangement? - The Evidence

5.2 The Public Representative and the Subvention Application

5.3 Nursing Home Provider’s Approach to the NAHB

5.4 Beds at the Roscommon Nursing Home

5.5 The Arrangement with the NAHB

5.6 HSE’s View of the Arrangement made with the Nursing Home Provider

5.7 The Family’s Understanding of the Placement in Roscommon

5.8 How Payment to the Roscommon Nursing Home was Arranged at the NAHB

5.9 Exclusion of the Roscommon nursing home from list provided to Scheme Administrator and Appeals Officer

6.0 Analysis – Public or Private Patient?

7.0 Application under the Health Repayment Scheme

8.0 The Appeals Process

9.0 Analysis – Appeals Process

10. Responses to the Draft Investigation Report

11. Findings

12. Conclusion

Appendix 1 - Statement of Complaint

Appendix 2 - Letter to CEO HSE

Appendix 3 - HSE's response to draft report

Appendix 4 - Emailed Response to Draft Investigation Report by Mr. Edmund Kent