On November 29, the Administrator of the Resources of the General Health Social Security System (Adres) announced new control measures to prevent fraud in the Health System.
(Read: In November, Adres transferred $6.88 billion to the health system: this is how the accounts go)
These measures seek to regulate claims related to traffic accidents that involve unidentified vehicles (known as “ghosts”) or vehicles that do not have Mandatory Traffic Accident Insurance (Soat). The implementation of these was formalized through Resolution 0199844 of 2024.
The new regulations establish that Clinics and hospitals that file claims with the Adres must present a copy of the descriptive report prepared by the transit agent. who attended the accident.
(Read more: Health reform: the project was approved in the first debate in the Chamber)
This requirement is based on Article 149 of Law 769 of 2002, which regulates procedures related to road incidents. If the report is not available, lMedical institutions must demonstrate that they immediately notified the judicial police or the first authority of the place about the admission of the alleged victim of the accident to the care center.
Also, the regulations are aligned with the provisions of Article 218 of the Code of Criminal Procedure, which establishes that any health establishment, whether public or private, that receives a person with damage to the body or health You must immediately inform the nearest judicial police unit or the corresponding authority. The objective of this regulation is to guarantee adequate registration of accidents and prevent possible irregularities in claims to the health system.
(See: How to know which EPS you are in, based on Adres data)
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Resolution 0199844 was later modified by Resolution 0204785 of 2024, which introduces a key clarification: the measures to verify the status of victim and The documentary requirements will only apply to traffic accidents that occur after February 1, 2025. This extension gives medical institutions and competent authorities a margin of adaptation to implement the required procedures.
(Read also: Adres suspends transfers for more than $70,000 million to allegedly non-existent IPS)
Fraud in traffic accident claims represents a significant problem for the Colombian health system. The filing of fraudulent claims not only generates economic losses, but also affects the availability of resources to care for those who really need them.
With these measures, Adres seeks to close spaces for irregularities and guarantee that the system’s resources are used in a fair and transparent manner. Therefore, the effective implementation of these measures will require a joint effort between the health sector, traffic authorities and judicial bodies to ensure compliance with regulations without affecting quality and the opportunity for attention.
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