Hospitals Write Off Over £250 Million in Unpaid Foreign Patient Bills

Hospitals facing financial difficulties have waived £256.4 million in debts owed by international patients due to inadequate verification processes confirming their eligibility for complimentary care. NHS treatment.

A probe conducted by The Mail on Sunday reveals growing financial burdens due to healthcare costs incurred by medical tourists – individuals who have received treatments ranging from spinal surgeries to cardiac care. cancer treatment – is creating a growing black hole in NHS finances.

Last year witnessed a loss of £44 million—a 63 percent rise from the £26.9 million written off by hospitals in 2017-18.

Our investigation, which scrutinized healthcare financial records spanning seven years along with a comprehensive Freedom of Information act inquiry directed at various trusts throughout England, uncovers critical insights as follows:

Only one-third of the £621 million debt owed by international visitors for hospital charges has been recovered.

A Nigerian patient who was scheduled for treatment at Barts Health NHS Trust in London accumulated a bill close to £500,000, while a Romanian patient owes Lewisham and Greenwich NHS Trust in South London around £71,000.

Over 400 international patients received elective care last year at the Barking, Havering and Redbridge University Hospitals NHS Trust located in East London, leaving 285 bills unpaid totaling £1.3 million collectively.

In nine years, the number of medical tourists utilizing the NHS for scheduled treatments has increased twofold, contributing to the escalating waitlists for patients funded by taxpayers.

The previous evening, following the MoS’s probe, the Health Secretary was faced with the findings. Wes Streeting pledged he would take action to 'tidy up this mess'.

Nevertheless, these numbers may just scratch the surface since they only account for patients who were flagged as needing to make payments—prompting concerns that an additional multitude of funds, potentially worth millions more, might not be getting caught in the system.

Conservative Party Member of Parliament Joe Robertson, who serves on the House of Commons Health and Social Care Committee, stated: "The UK should not operate as a healthcare provider for the global community. The National Health Service administration must collect payment from patients beforehand when providing scheduled treatments. This ensures that individuals with no intention to pay do not evade their bills."

'The NHS cannot justify asking for additional funds when they write off millions of pounds in debts owed by international patients for elective, non-emergency procedures.'

'If a tourist experiences an injury during their vacation in the UK, it's reasonable for them to get emergency treatment. However, it appears that the NHS is offering scheduled, non-urgent procedures to individuals from abroad who haven’t paid.'

'If the NHS management doesn't take control, then the Health Secretary should step in. Simply abolishing NHS England and bringing the NHS under direct government oversight isn’t enough if Wes Streeting can’t put an end to such blatant wastage.'

Over the last couple of years, the government has had to bolster the NHS’s funding by an additional £21 billion. Despite this increase, waitlists for hospital treatments continue to hit all-time highs, with only 59 percent of patients being treated within the targeted 18 weeks.

The £256.4 million written off could have funded salaries for approximately 8,500 new nurses or almost 3,000 general practitioners. This amount would also be sufficient to cover the treatment costs for about 27,000 breast cancer patients or finance up to 15,000 kidney transplants.

The circumstance where numerous foreign patients' bills pertain to treatments that are 'elective,'—meaning they were scheduled beforehand—has exacerbated the frustration.

Although general practitioner services and emergency treatment are provided without cost to everyone irrespective of their residency status, hospitals are meant to recognize chargeable patients and request payment up front—amounting to 150 percent of NHS rates—before providing additional care like specialized consultations and scheduled treatments.

However, the data shows that overburdened hospitals frequently overlook this step and end up sending bills to patients afterward — enabling them to depart the country without settling their payments.

This differs from healthcare systems in France, Ireland, the US, and Australia, where individuals must pay upfront.

Alp Mehmet, the chairman of Migration Watch UK, described it as 'outrageous' that merely a small portion of the expenses for foreign patients is being recouped.

‘Wes Streeting needs to encourage trusts to cease depending solely on government funding for providing non-urgent care to individuals who aren’t eligible for it,’ he stated.

'The creators of the National Health Service, such as Nye Bevan, would be appalled to discover it has transformed into an International Health Service.'

The NHS has billed overseas patients £621 million over the past seven years. Just £233 million – about a third – has been repaid, while the amount being written off is rising because patients can’t be traced, have died or because the hospital has chosen not to pursue the debt.

Despite this, in 2014, when concerns arose that the NHS was being 'too lenient' towards international patients, the government committed to recovering as much as £500 million annually.

John O'Connell from the TaxPayers' Alliance urged Members of Parliament to overhaul the system and 'show proper respect for citizens' hard-earned money'.

He said: ‘The fact that the health service is unable to even ensure those who are not entitled to free healthcare are paying what they owe is indicative of a culture that doesn’t care about wasted money.’

Every hospital must recognize patients who aren’t eligible for free NHS treatment and recoup expenses; this responsibility is monitored by overseas visitor managers.

This could include the use of the MESH system, an IT resource created by NHS England that compares a patient’s details with other databases, such as those maintained by the Home Office.

International patients ought to be informed about the probable charges as well as payment procedures, and healthcare facilities are required to undertake 'every reasonable step' to reclaim costs prior to initiating treatment.

However, out of compassion, official guidelines assert that care deemed urgent by a physician must not be denied — even if the patient has stated they are unable to make payment.

This is especially true in maternity wards, as denying care can adversely affect both mothers and infants.

Here, an invoice gets issued initially, followed by attempts to recoup the expenses subsequently. This could entail setting up payment arrangements.

Hospitals may resort to international debt collection agencies to recover these expenses; however, this approach is costly and does not ensure that the patient will agree or have the means to make payment, particularly if they are located.

A policy specialist remarked: "In truth, hospitals frequently find it unprofitable because hiring sufficient personnel to verify each patient's status and follow up on invoices after they're sent can be too costly. The effectiveness varies among different trust organizations."

These statistics encompass individuals who received initial attention at emergency departments before being hospitalized, leading to additional chargeable services. Additionally, they cover cases where general practitioners refer people to hospitals for scheduled evaluations or treatments.

Many hospitals struggled to distinguish between billing for elective and non-elective services. However, certain institutions like those in Barking, Havering, and Redbridge—where an outstanding debt of £1.3 million over one year encompasses a sum of £18,000 owed by someone from Ghana for orthopaedic procedures—did provide specific numbers. The University Hospitals Coventry and Warwickshire NHS Trust disclosed that they treated 531 international patients electively last year, with an uncollected amount of £22,000 related to spinal surgery.

The Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has verified that 396 international patients underwent planned procedures over the past year, leaving 194 bills amounting to almost £300,000 unpaid. In addition, cases such as a patient from Hungary who was treated for both kidney and heart issues at The Royal Wolverhampton NHS Trust and now owes £23,000 have been noted. There are also instances involving multiple individuals from countries like India and Cameroon who were given cancer treatments but still owe substantial sums, reaching into the tens of thousands of pounds each.

Data provided by the Department of Health and Social Care (DHSC) indicates that international patients seem to be more frequently opting for planned National Health Service (NHS) treatments.

Although the figures for individuals accessing emergency care haven’t significantly altered, the number of people admitted for day procedures has nearly tripled over nine years, rising from 3,885 to 8,585 between 2014 and 2022-23. However, this figure dropped to 6,205 in the previous year.

Data from The Mail on Sunday indicates that Nigerians held the highest amount of outstanding debt, trailed closely by Romanians, Indians, Albanians, and U.S. citizens. According to Mid and South Essex NHS Foundation Trust, within just one year, 92 Nigerian individuals accumulated debts totaling £238,553, which averages out to about £2,600 per person. Additionally, they charged 76 Romanian people with a collective bill of £178,936, along with billing 33 Albanian nationals an aggregate sum of £106,959.

The Mail on Sunday sought insights from multiple major hospital trusts regarding the challenges of recognizing chargeable patients and recovering such expenses, yet none agreed to comment.

The Nottingham University Hospitals NHS Trust acknowledged 'capacity' problems led to only around half of the patients identified by MESH as possibly chargeable being able to undergo additional scrutiny from their team. Out of over 8,000 individuals marked by MESH, approximately 5,130 received further reviews, with 982 ultimately receiving bills for their treatments. A number were excluded either because they qualified under an exemption or upon discovery that charges didn’t apply to them.

The DHSC mentioned they have recovered £4.4 billion from international patients since 2015-16. This sum encompasses all payments received through the Immigration Health Surcharge — an amount of £776 annually for those holding study or work visas to access the NHS — along with revenue generated from treating individuals from nations within the European Economic Area.

Mr Streeting stated yesterday evening: "Similar to how British citizens overseas must cover their medical expenses, visitors coming to this nation should also contribute towards healthcare costs. Given that patients here face excessively lengthy waits for general practitioner visits, surgeries, or emergency services, it is unjustifiable for the National Health Service to bear the expense of treatments that ought to be covered financially."

'We will take action to clear up this mess. While we strive to reduce waiting lists, we will simultaneously tackle those who are benefitting unfairly from British taxpayers' money.'