National Health Insurance (Senasa) failed to get the National Social Security Council (CNSS) revoke the resolution with which he was sentenced to pay 1,888,902 pesos due to delays in payments to the National Polyclinic Center.
The Superintendency of Health and Occupational Risks (Sisalril) imposed the sanction in April of this yeartaking into account that this was a recurring failure in the State insurer. Senasa protested with an appeal for reconsideration before the same Sisalrilwhich was rejected.
The institution then appealed the fine to the CNSS with a hierarchical resource that was known at the meeting on Friday, October 31. The advisors determined that the Sisalril acted in accordance with the principle of legality and reaffirmed their decision.
The defense
The legal representatives of the Senasa They focused their defense on refuting the legality of the Infringement Regulations and Sanctions to Family Health Insurance and Occupational Risk Insurance, created by the CNSSon which the decision of the Sisalril.
They argued that the Law 87-01which created the Dominican Social Security System (SDSS), did not give power to CNSS to approve regulations and that these had to be promulgated by the Executive Branch.
The Sisalril indicated that he acted in accordance with his legal powersbased on documentary evidence and that there was no error in normative interpretation or arbitrary assessment of facts.
Exemplary sanctions
It was a “objective evaluation of the omissive behavior of the ARS Senasa that directly affected the financial stability of a health service provider due to non-payment, a situation that must be addressed in a timely manner by this Sisalrilimposing exemplary sanctions as that of the species, to prevent practices like these from continuing to be repeated, and thus prevent the instability of the Dominican Social Security System”, according to the Sisalril.
He CNSS responded to Senasa that the aforementioned regulation was published in a newspaper of national circulation and that it was promulgated by the Executive Branch in 2012.
Recurring absences
Senasa has been punished to pay a total of 9.5 million pesos in recent months for recurring breaches of payments to providers and denial of services to its members, while suffering a financial and credibility crisis due to several corruption scandals.
The Sisalril warned in his rulings that it was a prolonged pattern of non-compliance that put at risk the liquidity, profitability and operational capacity of the contracted suppliers.
A technical report It also warned that these delays could translate into restrictions on access to medical care for members and difficulties in paying the employee. health personnel.
The institution pointed out that it was not an isolated case, but rather a repeated situation supported by multiple complaints received, which formed a continuous administrative violation and contrary to the current regulations.
For this reason, he ordered the application of corrective measures and started a sanctioning process for the state insurer to correct the arrears in its financial obligations.
Sisalril reported that it is advancing in the formulation of two programs that the National Social Security Council (CNSS) established at its meeting on October 31 aimed at improving access and coverage of high-cost medications.
The first is a Fund for High-Cost Medications, which will operate as a special account in the Social Security Treasury (TSS) and will allow resources to be accumulated for a group of treatments with high financial impact.
The second proposal proposes the creation of Insurance for Catastrophic Illnesses, which would protect the entire affiliated population and would require the modification of Law 87-01.
