Health chiefs have not been given "pre-cooked" orders on the number of medical cards to cancel to hit a 113 million euro savings target.
Amid deepening concern over sick people no longer getting free care, new figures revealed 428,682 medical cards have been reviewed this year.
The 113 million euro (£95 million) savings from the medical card bill is part of the wider 666 million euro (£558 million) cuts in health.
The medical card figure was set down by the Government on the back of advice by accountancy giants PwC.
Tony O'Brien, Health Service Executive (HSE) director general, rejected any assertions that officials have been told to cancel a set number of cards.
He said the figures for savings "do not come pre-cooked" with the number of people who should lose cards.
"Probity is a broad term which relates to ensuring that medical cards are issued in full compliance with the legislation and guidelines and that medical cards that are not in compliance are not in issue," he said.
"The figure of 113 million does not change anyone's eligibility criteria."
Mr O'Brien said speculation on the number of people who will lose medical cards as the HSE seeks savings of 113 million would cause fear and alarm.
"It would not be wise or prudent or in the general interest to be speculating what the outcomes would be," he said.
Elsewhere, the HSE confirmed that it had sought an additional 10 days to finalise its service plan for next year. It has asked to be given until November 25.
On the medical card controversy, the HSE said about 45,000 medical cards have been withdrawn since January 1.
Some 10,393 medical cards issued on a discretionary basis have been taken from patients and either replaced with GP cards, full medical cards or none at all.
Since October 1, 38,495 people have been removed from the system after their medical cards were found to have been inactive.
The HSE said it expects to have reviewed 600,000 medical cards by the end of the year.
About 35,000 of the 350,000 over-70s who have medical cards are expected to be moved to the free GP visit card, the HSE said.
Approximately 1.86 million people have a full medical card as well as 123,424 with a GP-only card.