Santo Domingo.- This newspaper found a fraud scheme used by a chain of Pharmacies against affiliates to the National Health Insurance (SENASA), through false reports of medication sales.
The case came to light when an affiliate called a pharmacy to claim a consumption of RD $ 1,817.00 that he never made. When complaining and threatening to take the case to the authorities, an employee of the pharmaceutical chain He admitted the irregularity and proposed to reimburse the fictional amount, Add five thousand pesos in cash and facilitate prescribed medications for life.
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This fact confirms the fraud schemes from which Senasa users were victims, exposed in the report of the Government Anti -Fraud Unitwho delivered the findings last Saturday to the Attorney General’s Office.
One of the schemes was that the data of Senasa affiliates was used to orchestrate millionaire fraud without the insured’s own themselves.
The renowned pharmacy chain used the personal information of affiliates to record false authorizations.
The modus operandi consisted of identifying affiliates who had not consumed the entire annual coverage of 12 thousand pesos for medications. These were discounted amounts from up to three thousand pesos fraudulently, without making any real sale.
The operation was executed fair before the deadline for using the benefit, taking advantage of those funds are not cumulative and are lost at the end of the calendar year.
This type of fraud is based on the fact that affiliates have the right to consume up to 12 thousand pesos a year in medicines prescribed by doctors, but under the condition that The amount is not cumulative. That is, if it is not used during the corresponding year, it is lost and the balance starts from scratch at the beginning of the following year.
