An audit conducted by government health agency SuperSalud has found numerous irregularities in the provision of medication and mismanagement of funds by numerous Colombian health insurance companies, reported RCN Tuesday.
One out of five health services approved by the health insurance companies to be reimbursed came under the Compulsory Health Plan (POS), a scheme used by Colombia’s private medical insurers to provide a minimum level of healthcare services to its customers.
This has resulted in a huge number of cases of double billing, whereby insurance companies have gone to the government agency Fosyga seeking reimbursement for medication they provided to patients, despite the fact that the organization had already paid for it to be covered by the POS.
In addition, a further 55% of 183 medications ordered by patients who petitioned to receive the treatment for free, were in fact already covered by the POS, a clear denial in the provision of health services.
The actual cost of the apparent scandal will only be determined after a second round of investigations takes place to examine the individual accounts of each of the 15 companies involved in the irregularities.
The inspection also revealed that in one week the health body managed to complete 733 medical cases. Superintendent Conrado Gomez Adolfo said that to complete so many cases with all the necessary analysis “is just not possible,” pointing to the possibility that false documentation was filed in order to charge
The case will be debated in Congress on Tuesday, along with recent reports that 14 health insurance companies made a pact to agree not to fund certain health services even though they are covered in the POS.
For more information on the Colombian health care system read here.
