The Malta Independent 26 April 2019, Friday

Data on treatment given to foreign patients at MDH did not interface with billing systems - NAO

Tuesday, 4 December 2018, 17:06 Last update: about 6 months ago

Information on medical services given to foreign patients at Mater Dei Hospital is not interfaced with the billing systems; thus it does not provide the comfort that the invoices raised are exhaustive, an NAO audit has found.

The anomalies encountered in the respective financial records that are inputted manually also cast doubt on the reliability of the related information. Additionally, a number of weaknesses were identified in the revenue collection process and efforts to collect public dues were found to be minimal, the NAO found.


The audit covered fees charged by MDH to foreign nationals who do not qualify for free healthcare.

Financial Estimates indicated that estimated revenue for 2017 from Hospital Fees was €150,000 whilst actual revenue recorded on the Departmental Accounting System (DAS) in this respect amounted to €581,858.


The NAO said the scope of the audit was limited due to a number of factors:

• the two systems used to generate invoices do not interface with the clinical software systems;

• electronic information regarding medical services provided to a patient from the various departments within MDH is not integrated;

• bills charging foreign patients who are ineligible for free healthcare are generated on the basis of handwritten details listed on pre-printed forms. Thus, the completeness of the information is not guaranteed;

• differing interpretations are being given to the subsidiary legislation stipulating fees charged to foreign patients; • various fees charged for different medical procedures are not covered by legislation and therefore are not legally sanctioned; and

• there is no control to ensure that all foreign patients who are not entitled to free treatment are billed accordingly upon discharge from MDH. In view of the above, NAO could not confirm whether bills raised were comprehensive


The NAO said that, considering the increasing demand by foreigners for the Hospital’s services, the establishment of a comprehensive patient billing system is to be given priority.

This is expected to be automated and fully interfaced with other hospital information systems, such as medical records and clinical systems.

NAO is aware that, in January 2016, a call for tender was issued by the Department of Contracts for the Provision of a MDH Billing Service, but a contract in this respect was still not signed by the time the audit was concluded.

The hospital said the NAO has been notified on the Department of Contracts’ recommendation that the said Tender should not be awarded to the second bidder but cancelled and re-issued.

“Nevertheless, MDH is still in favour of procuring the service and is actively considering which procurement process to adopt in order to obtain such a service in the shortest time possible. The contractor concerned will not only ensure a tighter control on paying patients but will also act as a credit controller, which routine MDH does not have.”

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