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The Editor Speaks: HSA debt is over $100M

One of the practices in place at the Cayman Islands Hospital when you go to the Clinic to see a doctor or get a prescription refilled is to charge you $75 BEFORE you get to see a doctor, or in the case of a prescription refill, you actually don’t see a doctor. And the prescription refill is for one month only. The hospital receives $75 for the writing of a prescription that takes a minute of time to execute.

Therefore I would think the Health Services Authority (HSA) would be making tons of money on that alone if you work out the number of refills that are carried out at the George Town Hospital alone.

Not so.

We learnt from the Public Accounts Committee (PAC) this week that based on the evidence given by HSA board chair Jonathan Tibbetts, the accumulative debt is currently $108 million!!

Even worse – over half was accumulated over a twelve-year period, the rest over the past TWO years.

Apparently this policy of paying up front was brought in because of self-pay patients that have no insurance, are under-insured or who have used up all of their benefits and who have not paid their bills or co-pay element of the bill.

The problem is do you send sick people away who have no insurance and/or no visible means to pay?

Accountants would have their answer to that one! We are all a line on a piece of paper.

To collect the debts a local agency was employed but was only able to collect 3% of the outstanding monies over a two year period.

There is another plan in the works, however, HSM are being employed, the final details still to be worked out, to collect just $1M of the $108M debt.

Not surprisingly, the PAC committee were not overly impressed.

The government’s insurance company, CINICO, has contributed to the vast majority of the last two years massive debt. They changed their third-party adjudicators twice in the last three years, impacting the payments.

Why? I would love to know the back story surrounding that decision!

The PAC was not finished with HSA as another very thorny subject came up – the persons involved in the CarePay hospital card contract and Canover Watson. Watson was the only one charged and jailed for his involvement with the fraud.

Watson had siphon off supposedly millions of dollars as a result of his corrupt dealings when he was chairman of the HSA.

Twelve other individuals had also signed off on the CarePay fraud but no one to date has been sacked.

The Auditor General had given specific instructions as to the introduction of anti-fraud policies to prevent a similar CarePay situation from happening but amazingly these policies had not been introduced.


The same management team that allowed the fraud to take place were still there.

These questions were asked by PAC but no satisfactory answers were provided.

If this had happened in the private sector things would be very different but it appears working in the government sector is a job for life no matter how incompetent you are. And if you are suspended for something that would have meant firing and police charges made for suspected fraud in the real world, you get full pay for doing nothing and hope the suspension goes on ad nauseam. It often does and then you retire with no stain upon your character.

Things at HSA are improving we learnt. Because of new concerted efforts now in place to improve collections and address the bad debt, the $108M debt would have been even worse. We didn’t learn by how much!


  1. In the Eighties the audit work was subcontracted to my firm Coopers and Lybrand. The hospital just could not collect the receivables. This problem has been going on for thirty years or more. This is no real answer. Ironically I got a statement for fees owing, asked for details and got no response. Hopefully that is fortunate for me as another individual shares the same name.


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