He Public Ministry detailed the operational modalities through which the fraud against him National Health Insurance (Senasa), attributed to the accused in the file known as Operation Cobra. The indictment describes a sustained scheme of irregular billing, administrative manipulation and diversion of public funds.
According to the accusation of Public Ministry in the Operation Cobrahe fraud against him National Health Insurance (Senasa) was executed through the following operational modalities:
Medical services not realized
HE billed studies, procedures and treatments that were not executed, using affiliates real and authorized providers.
Partial services charged as complete
Procedures carried out incompletely were reported as fully executed, generating higher charges.
Duplication of procedures
The same member is billed procedures identical in close periods, without justification clinic.
Repeated diagnoses
Similar or identical diagnoses were used in different patients to support authorizations and payments.
Medically incompatible services
They were reported procedures incompatible with each other within the same period (for example, internments and outpatient care simultaneous).
Repeated use of affiliates
Certain affiliates were used recurrently as support for multiple claimsin some cases without their knowledge.
Administrative coordination of the fraud
Intermediaries managed the coding, presentation and monitoring of claims to meet formal system requirements.
Dispersion of the payments
The funds paid by Senasa were channeled to natural persons and legal matters linked to the accused.
Conversion in estate
Part of the money was used to acquire real estate and other assets, which led to the accusation of money laundering and the judicial immobilization of estate.
