The Comptroller warns of Medicare payments for the deceased – investigation – justice

Although a citizen passed away on December 12, 2014, In state records, it appears that 11 million pesos was paid to IPS for his care After this person had a traffic accident on September 11, 2019, five years after his death.

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This is how it appears in a file Controller Audit On the collected resources To the Director of Public Health Social Security System Resources (Adres) corresponding to orders for the care of persons injured or killed in traffic accidents where the vehicle in question did not have the Compulsory Traffic Accident Insurance (Soat) for the said concern.

These resources also include medical attention for people when the motorist involved in the accident flees the scene.

For the care of a person who died on November 17, 2015, 17 million were paid for an alleged accident recorded on December 10, 2012, and, according to the prosecution, he lost his life.

in your check, The Comptroller found a total of 13 cases in which 102 million pesos were collected “Potential undermining of public social security system resources in health for this amount”.

The supervisory authority pointed out that in the corresponding review of 2018 and July 2021, a weakness was revealed in some of the controls established for this type of procedures.

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Apparently, health providers provided the same support more than once to most likely demand two or three times the same recognition for the transportation service

The report mentions other infractions related, for example, to the supposed provision of the ambulance transport service for patients. It was revealed that a charge for this emergency vehicle service was charged to transport patients located in different places and far away to health care centers, though, and the report shows the services of the same ambulance with only five minutes difference between one transfer and another.

The watchdog considered it unlikely that these would be filed very quickly, so it warns that “one of the documents differs from reality”.

These positions were mostly identified in IPS in Valle del Cauca and Córdoba.

The special inspection procedure also draws attention to Alleged double payments for ambulance transportation expense claims For the same user and incident, with different submission dates, at $102,745,121.

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“It is clear that health providers provided the same support more than once to claim the same transportation service recognition two or three times and that Adres made double payments for these claims,” the entity said.

In accidents where the vehicles in question do not have Soat, the costs of transportation and medical care of the injured are borne by the state. (Pictured: an accident in Barranquilla).

picture:

Courtesy – Private Archive

Cascade services?

One of the most serious findings in the report is the possibility of forming a service cartel that will be concentrated in some of the services of industrial companies in the country.. It was cautioned in the review that it was revealed, for example, that despite the presence of a care center near the site of the accident, the patient was moved to a remote location coinciding with the IPS where there are a large number of injured people.

These types of cases have been identified in Atlántico, Bolívar, Córdoba, Magdalena and Valle del Cauca, regions where claims are concentrated in one, two or three IPS.

The review alerts, for example, that although a care center was located near the accident site, the patient was moved to a remote location coinciding with the studied IPS.

The Comptroller’s Office said Inversiones Azulud, in Magdalena, concentrates 43.46 percent of total certified values ​​of care derived from No Soat traffic accidents; In Córdoba, Especialistas Asociados SA concentrates 85.5 percent of the claimed values ​​for this concept; In addition, in this section, in 100 percent of cases for the transfer of victims, the wounded were transferred to the Israel Prison Service.

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According to the report, There are 786 claim records that the oversight body has been able to georeference.“whose accident led to the filing of a claim (…) attended by Intensive IPS (Inversiones Azulud SAS, Bahía SAS Diagnostic and Imaging Center, Bahía SAS Medical and Rehabilitation Center) and/or the patient was transported by ambulance.

Among these claims, 281 IPS center care records were identified where there was a medium and high complexity of IPSs closer to where the events occurred.

It turns out that RUC Magdalena SAS for patient transport appears in 786 claims and In all cases, take the wounded to the same place: IPS Inversiones Azulud SASThe company has an approved value of 209 million pesos.

Due to irregularities in car accident care without Soat coverage, 13,955 million pesos were to be paid, between 2018 and July 2021

Similarly, a woman appearing as a legal representative for the ambulance company Red de Emergencias de la Costa y de Tecnología Diagnostica del Sur en Atlántico and the ambulance company RUC Magdalena, was also the deputy director of Inversiones Azalud SAS, in Magdalena, one of the IPS accessed by more patients .

The report says that in the province of Córdoba, it was found that in one hundred percent of the claims related to the transfer of victims, IPS Especialistas Asociados SA appears, for which 85 million pesos were paid. And in Valle del Cauca, claims were concentrated in the clinics of Cristo Ray, at 70 million pesos, and at Fabilo, at 58 million.

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On account of offenses in the care of road accidents without Soat coverage, 13,955 million pesos were paid, in the periods 2018 through July 2021.

“Given the clear concentration of claims related to traffic accidents with some service providers, Has been chosen Lack of control points that can measure and prevent situations that lead to inappropriate practicesconcentration or bias of services that in the future lead to a potential cartel,” the monitoring agency’s report warns.

On Twitter: @JusticiaET
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