Written evidence from the Global Recovery Alliance

Introduction of Global Recovery Alliance AG:

Since 2007 Global Recovery Alliance has been assisting many UK NHS Trusts with their out-of-country debt collections for (mostly non-EEA) overseas visitors that are not eligible for free NHS treatment. Global Recovery is a specialist international (worldwide) medical debt collection company that assists many hundreds of hospitals around the world in this regard.

Global Recovery has debt collection statistics for NHS overseas visitor cases submitted to us since 2007. It says in the guidelines that no addendums can be added to an Evidence submission so please let me know if you would like to see these figures (excel spreadsheet reports) from say two Trusts in London and one Trust in Birmingham from 2007 – 2016?

The reason I am submitting this evidence is that we would like to assist the NHS collect more than it does from people and countries that should be paying the NHS for their medical treatment (and paying for the medical treatment of their citizens) whilst these people are in England.

Executive Summary:

1. Global Recovery Alliance has a unique perspective on the overseas visitor collections that the NHS is trying to effect. We have successfully collected (approximately) 10% of the total value of Non-EEA cases submitted to us for collection by NHS Trusts since 2007. N.B We usually only see these cases when a Trust has exhausted all possible avenues of self-collection and when they have time/remember to send them over to us i.e we only get the hopeless/very difficult cases that are usually six-months to a year old or older.

Questions and answers from the Audit report:

1. EHIC / EEA patient Collections:

Has an Audit been done on which EEA countries have received EHIC bills from the UK and which haven’t? Has an Audit been done on whether the countries are paying the UK what they should be paying when they have been billed? Are there any countries that have never paid their EHIC bills?

Is there a “Master List” of countries that have waiver agreements/ formula agreements? Who agreed these waivers/formulas? Are they still beneficial to the UK?

Do the individual NHS Trusts have this up-to-date master waiver/formula list to avoid the extra work submitting cases that won’t ever be paid to them?

Is there a separate (simplified/quicker?) EHIC bills submission process for countries that do have a waiver/formula in place once the patient shows they are from one of those countries?

Why don’t Trusts get paid if there is a waiver/formula in place? It appears very unfair that the Trust takes the hit of non-payment by EHIC if the Govt. has agreed a waiver/formula?

2. Non EEA patient collections

At Global Recovery we use an (NHS approved) statement on our collection letters stating that non-payment of an NHS bill will be reported to the Home Office and may affect your chances of getting a visa in the future. This has definitely improved the overall patient response to our letters.

Why is the 50% non-EEA charge paid by the Commissioners paid upfront? This makes a huge disincentive for the Trust to try to collect the 150% charged if 50% (or 75% of the normal NHS charge) is automatically paid up front. In the last 12 – 18 months we have seen a marked decrease in the number of cases being sent to us from all NHS Trusts that use us. We think this is primarily because after a hospital receives 50% of the 150% billed charges upfront, they are happy with that and don’t bother to try and collect the 150% charged from the patient or send the case to us!

If the Commissioners are paying 50% of all non-EEA bills upfront, are the Commissioners thinking about doing some collections work themselves or employing specialist international collections firms to help them with said collections? If not, why not!

Is the NHS Cost Recovery Team involved with individual collections work at individual Trusts? If not, why not? Leading by showing is very important. If the Cost Recovery Team can’t collect an example few debts for the Trust they are visiting, how is the Overseas Visitor Manager meant to do any better?

General Recommendations and Thoughts:

Why are Primary Care services and GP’s services not charged for? GP’s in Switzerland make a large charge for the first five minutes of their time then smaller charges for the subsequent minutes.

Why aren’t GP and Emergency services, physician services, radiology services etc. added onto the overall end hospital bill, especially if the patient is non-EEA? This is done in the USA, Switzerland and many other countries.

What is community healthcare and why is it not chargeable for non-UK people?

Why are reciprocal agreements not always reciprocal? e.g An Australian in the UK gets free GP surgery as if they are an NHS patient but a Brit in Australia doesn’t?

The Migration Surcharge: Could this £200 be better spent on getting the person who paid it a private UK healthcare insurance for the time they are in the UK? If it could be done then any medical costs incurred by them during their stay can be charged to their new private insurance. This would allow the NHS to recover far more than a maximum of £200 per person.

Why are Teaching Trusts particularly bad at collecting their debts? Perhaps the guest doctors/teachers all invite their families over to see them from their home countries and then are more easily able to get away with the Trust not charging their relatives? Also, perhaps teaching hospitals are not in traditionally touristy places so the Teaching Trust is not set up to deal with foreign patients like a London trust would be?

Why was there only limited use of training materials? Because however much you train somebody, if (for example) they are not from India and cannot speak or read Hindi, then they will not be able to trace somebody in India or collect a debt in India. If you are not able to speak Arabic you will not be able to collect a debt from Arabic countries. The same goes for Russia, China, Japan etc. etc. and if you are trying to collect a debt from a P.O Box address in Nigeria, you will definitely not be successful unless you have friendly Agents on the ground in Nigeria! It has nothing to do with training and more to do with knowing you are simply wasting your time trying to collect on those very difficult to collect international debts! As an example, we have 20+ languages in-house so we can speak to people all over the world and so we can and do collect from these difficult to collect places. How many languages do most Overseas Visitor Managers within the NHS speak?

As is correctly stated in the Audit, the biggest problem for NHS hospitals is recognizing that a patient is not eligible for free NHS treatment at the time of service. With no mandatory Health card/ID available the hospital is simply taking people at their word (And perhaps more importantly on the referring GP’s word!). Once you are “in” with a GP, there is practically no “who are you” control done after that time. If the GP then recommends the patient onto a hospital as an NHS patient the hospital treats them as such.

Is the Online Forum for Overseas Visitors Managers used at all? Is there a list of approved assistance / international collections companies on the Forum anywhere that the Managers can access to help them collect their overseas problem cases? If not why not?!

Finally, to assist the NHS hit their debt recovery targets for 2017/8 Global Recovery Alliance AG would welcome seeing any and all non-collected overseas patient cases that the NHS has on their books going forward from here. No collection - No fee.

We charge 32% for individual Trusts to use our services but we would knock that down to 25% for everybody if we were to get an “umbrella” NHS collection contract so that anybody and everybody can use us when they have a need.

Since 2007 we have collected an average of 10% of all the cases submitted to us by NHS Trusts, so, if all the money written off by the NHS these last 3 years (£15.7 + £16.9M + £15.2M) had been sent to us first we would have sent you nearly £5 million pounds back to help the cause.

7 December 2016