LAR patients have received free treatment at most hospitals in this country ever since it started over 20 years ago. But last week, news told that several hospitals in this country have introduced payment for treatment of LAR patients. One of the hospitals that now takes payment from LAR patients is Stavanger University Hospital (SUS). This is LAR Drug-assisted rehabilitation, also called LAR, is a nationwide treatment program for people who are addicted to opioids, most often heroin. The aim of the treatment is to increase the quality of life of the users and reduce the number of overdoses. The patients undergoing rehabilitation receive morphine-like drugs, either methadone or buprenorphine. Through LAR, the patients will also receive financial guidance and help to find a place to live. There are 8,198 patients in LAR as of 2021. Source: FHI/SERAF/Helse Stavanger Now news can reveal the reason why LAR treatment is no longer free at this hospital. Before the hospital introduced payment for the patients, they sent the bill for the treatment to Helfo. This must have happened illegally, according to Helfo. An inspection by Helfo shows that the hospital has received unlawful payments from the state in the period 2019–2021. Stavanger University Hospital has sent patient bills to the state of over NOK 12 million during the two years and received money they should not have, Helfo believes. Now Helfo is demanding repayment of the amount with interest of over NOK 14 million. And the victims become the LAR patients when the hospital has to pay the money claim. Monika Mikalsen got a whole new life after the treatment she received free of charge at LAR. – With the new requirement for self-payment, more people will drop out, she believes. Photo: Cathrine Oftedahl / news The hospital has introduced a deductible of NOK 375 per hour. news has previously reported that patients are therefore dropping out of treatment now. Use of the exception rule as the main rule – One of the reasons why we checked Stavanger University Hospital is that they have used the exception rule much more than other hospitals. This is what the head of section in Helfo control, Bente Fjeld Ludvigsen, says, who takes the matter seriously: – These exceptions for the deductible are narrow, and LAR patients in most cases will not fall under the exceptions in the regulations. Nevertheless, SUS has sent bills to Helfo for these patients, the check shows: None of the bills that have been examined are justified. In addition, a third of the bills are not documented. A quarter of the bills are triggered by employees who do not have the right to demand money for the treatment. – Have not engaged in cheating – We have acknowledged that our understanding and practice have been more generous than the rules allow. We have also acknowledged that we have not documented sufficiently in some cases. We have therefore changed our practice in line with the guidelines from Helfo, says Randi Mobæk, head of department for substance abuse and addiction treatment at Helse Stavanger. LAR Helse Stavanger has sent patient bills to the state of over NOK 12 million during the two years, and received money they should not have had, Helfo believes. Photo: Thomas Ystrøm / news Helfo, for his part, believes that the errors are not due to a lack of knowledge about correct use. – We do not agree with that. We have acted based on what we believe is in the best interests of the patients, and that we have grounds for using the exception provisions more than Helfo believes. We have not engaged in cheating, as Helfo suggests here. – But should you have known? – We have acted based on the best intention and purpose. We have considered that we have had sufficient professional arguments and documentation that we could use the exception rules. Treatment rooms are empty after Stavanger University Hospital introduced a deductible for treatment for LAR patients. – More and more people are dropping out of the therapy sessions, says Randi Mobæk, head of department for substance abuse and addiction treatment at Helse Stavanger. Photo: Cathrine Oftedahl / news Sent bill for healthy person Helfo lists health care for which SUS has sent a bill to the state, but which, according to Helfo, is not allowed: Medicine distribution, doctor’s appointment bookings, covid surveys, group meetings, conversations without therapeutic content and urine samples. – Here we disagree with Helfo on what is included in the term “health care”. We believe our practice is in accordance with national professional guidelines. Therefore, we have based a different assessment than Helfo in what is covered by the state. It is in particular the use of the rule on the patient’s state of health that Helfo criticizes the hospital for. According to the rule, the hospital can demand money from Helfo if the patient is too ill to pay the deductible himself, for example where the patient is psychotic or significantly intoxicated. But here the hospital has sent bills to Helfo for patients who, on the contrary, have been in good shape, the decision shows. – Most of our patients have serious addictions, often in combination with other extensive somatic and mental illnesses. The format of the day can vary, and we have therefore looked holistically at the patient’s state of health, says Mobæk Rules on collision course with professional advice Mobæk believes that the way the rules should be understood and handled varies a lot around the country. And she gets support from several quarters. The professional council, which is the drug field’s main organisation, believes Helfo interprets the rules too strictly. – We believe that Helfo overrides political signals and professional judgment in this matter. It is disturbing, says leader Jan Gunnar Skoftedalen. Head of the Faculty Council, Leif Gunnar Skoftedalen. Photo: Synne Dahl Network leader for LAR and general manager of the drug and addiction outpatient clinics section at Oslo University Hospital, Kine Haugen, supports Mobæk in that it is not given how the rules should be interpreted. – The wording which states that an exception can be made from the deductible when the patient’s condition prevents payment, for example in the case of mental illness, can be interpreted both narrowly and broadly. Network leader for LAR and day-to-day manager of the Drug and Addiction Outpatient Clinics Section at Oslo University Hospital, Kine Haugen. Photo: Privat She believes that an exception rule should be established for all patients in LAR. – This must apply to all healthcare, not just the distribution of medicine. The medicine only forms a small part of the overall treatment that LAR patients need. – The Ministry of Health must decide Professor of law at the University of Bergen, Jan Fridthjof Bernt, says this is a matter that should naturally be presented to the ministry. Professor of law at the University of Bergen, Jan Fridthjof Bernt. Photo: Kjetil Rydland/news – Here there is a disagreement between two state institutions. Whether Helse Stavanger should have understood the rules as Helfo claims is correct is up to the ministry to decide. – We would have liked to have received better information regarding how the rules should have been followed, says Mobæk. She points out that they repeatedly contacted them, without getting clear answers back. Helfo writes in the decision that they have no information that Helse Stavanger has been in contact with Helfo to clarify the correct rate usage. – What would you say to the LAR patients who now have to pay the bill? – It is unfortunate and regrettable that the situation is as it is. But we hope that they will still be processed, and we would like to remind you of the scheme with free cards. In Bergen, LAR patients do not have to pay. Instead of demanding a deductible from the patients, they have reduced the number of positions at the hospital. Certain LAR patients must pay for the treatment, while others do not. Drug organizations believe there is a crisis, and want free offers for everyone. From left Espen Aas, regional manager of A-larm, Marianne Cook Pierron, Prolar Nett, Bergen and Morten Sommerbakk, regional manager of FHN Vestland. Photo: Victor Meisfjord / news – Has Helse Stavanger considered doing the same as Helse Bergen – taking the bill themselves, so that the LAR patients do not have to pay a deductible? – We have considered that several times, most recently this week. But have been refused by the hospital management every time, says Mobæk. Economics and finance director Tor Albert Ersdal at SUS says in a comment that there is reason to look at the matter again, and points to the example of how practice is in Bergen. The practice has taken place since its inception According to Helfo, Stavanger University Hospital has used exceptions in the regulations as a general rule systematically over two years, but how long has this practice actually taken place? – We have practiced the rules in the same way since Helse Stavanger took over the LAR treatment since 2009, says Mobæk. Helse Stavanger has appealed the case to Helseklage. – Although we have paid the fine and corrected our practice, we do not agree with all of Helfo’s assessments. The Ministry of Health and Care has previously stated to news that they will consider a rule change. – So that LAR patients can get an exemption from the deductible when they receive outpatient treatment in the specialist healthcare service. We are now looking at the consequences of any such rule change. A possible deductible exemption will increase the state’s expenses and will therefore have to go to the Storting, writes State Secretary Ellen Rønning-Arnesen (Ap). Deductibles for LAR patients Deductibles that patients pay are included as part of the financing of the public health service. In certain situations, the hospital can use exception rules, so that the patient does not pay this deductible. To ensure that the hospitals also receive income from the patient groups covered by the exception rules, the hospitals can send claims to Helfo and Helfo will then pay this deductible to the hospital. The exceptions in the regulations are narrow, and LAR patients will in most cases not come under one of the exceptions in the regulations. See the exception rules here: https://lovdata.no/forskrift/2016-12-20-1848/§5
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Helse Stavanger must repay millions. LAR patients get burns – news Rogaland – Local news, TV and radio
