Detriment due to failures in Invias works could add up to $50 billion

There are irregularities for $13,955 million in ‘no soat’ claims

The Comptroller General of the Republic established seven tax findings for $13,955 million at the end of a Special Supervision Action to the Administrator of the Resources of the General System and Social Security in Health -Adres-, related to alleged irregularities in traffic accident claims ‘no soat’ in the periods 2018 to July 2021.

(Comptroller’s office opens fiscal process to Ecopetrol for $2.4 billion).

The largest tax finding, for $7,583 million, has to do with the non-recovery of resources in ‘no soat’ claims for the legalization of previous drafts, where the ADRES made a larger disbursement to 16 IPS and one of them (the Clínica Jaller, in Barranquilla) concentrates most of this portfolio ($7,438 million). In this case, the Comptroller’s Office warned of a possible materialization of the risk of recovering the resources owed, due to an uneconomical management of the entity, since there is the possibility that new filings will not be carried out or that there may be possible forced interventions and/or a liquidation stage that limits its reimbursement or that leads to the disbursement of more administrative (legal) expenses for this purpose.

A second fiscal finding on the same subject, the legalization of the previous drafts in these ‘no soat’ claims with higher amounts disbursedreaches the sum of $6,021 million and refers to: A higher value canceled without accounts receivable for $4,911 million and a higher value of accounts receivable that were not registered by the ADRES and reach $1,110 million pesos.

The comptroller’s office concluded from the evaluation made to the management of the Adres on the subject of health care claims derived from ‘no soat’ traffic accidents is that “some of the controls established for this recognition and payment procedure present weaknesses, as well as as the absence of control points. And it is worrying that, in all the cases detected, the monies disbursed without just cause have not been returned to the General System of Social Security in Health.

In addition, the control entity warns of a permanent exposure of the resources of the Adres against third parties that present recoveries or claims without just cause and to fraudulent conduct that may negatively impact SGSSS resources.

On the other hand, the Delegate Comptroller for the Health Sector confirmed the occurrence of irregularities detected in alerts given by the Diari at the end of 2021 regarding claims filed during the period 2018 to July 2021 by health providers who attended victims of traffic accidents without SOAT, due to a ghost vehicle or a hit-and-run.

The first irregularity that was verified are alleged double payments of claims for ambulance transportation expenses for the same user and accident, with different filing dates, for $102,745,121. It is evident that the health service providers presented the same support more than once to presumably claim 2 or 3 times the same recognition for transportation service and that the ADRES made double payments for these claims.

They also found doubles deceased compensation payments, for more than $25 million. Among the claims for compensation for death, the CGR evidenced that the ADRES audited and paid claims that it had previously recognized.

“These two situations of double acknowledgments in the claims affect the resources of the health system and constitute an uneconomic management, with an alleged loss of assets of more than $128,528,897,” indicated the Comptroller’s Office.

In the case of ambulances, the entity found that some carry out the transfer of victims of different accidents with less than 5 minutes between each transfer, from different directions and far from each other, revealing a materially unlikely situation.

“It cannot be believed that the ambulance leaves a victim in an IPS and picks up and takes another in 5 minutes or less,” said the Comptroller. These situations have been identified mostly in IPS of the Department of Valle del Cauca and some in the Department of Córdoba.

For this claim for the payment of a service not provided, a tax finding was determined for $12,179,152.

Another relevant finding, with a disciplinary incidence, has to do with the fact that there is a small group of health providers that concentrate the claims to the Adres for traffic accidents where the Soat was not available.

They are located in the departments of Atlántico, Bolívar, Córdoba, Magdalena and Valle del Cauca. “It is evident for these departments that the claims are concentrated in one, two or three IPS. As an example, the case of Inversiones Azulud in the department of Magdalena is mentioned, which concentrates 43.46% of the total approved values. for care derived from non-SOAT traffic accidents. And for the department of Córdoba, an IPS (Associated Specialists SA) concentrates 85.5% of the values ​​claimed for this concept”, concluded the CGR

On the other hand, some people identify themselves as legal representatives of some IPSs, being at the same time substitutes or partners of other IPSs where precisely the concentration of claims is presented. This occurs in departments such as Atlántico, Magdalena and Valle del Cauca.

Finally, the CGR determined that in the department of Córdoba it is identified that in 100% of the claims for the transport of victims, the injured are taken to the IPS Especialistas Asociados SA

“According to a georeferencing exercise carried out by the Diari in the departments of Atlántico, Bolívar, Córdoba, Magdalena and Valle del Cauca, cases were identified in which the ambulances transported the victims to the concentration IPS, despite the existence of IPS closest to the place of occurrence of the event, thus putting the health of patients at risk, “concluded the Comptroller

In conclusion, in the analysis carried out by the Comptroller, it was shown that about 1% of the providers concentrate 30% of the services provided and 44% of the resources approved by the Adres in the period 2018-July 2021.

Likewise, they also determined payments for 13 ‘no soat’ claims filed with the Adres of health services to people who had died before the date of service provision. This situation affects public health resources for $102,010,141, generating a possible reduction in the resources of the General System of Social Security in Health for this amount.

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