Colombia’s health system paid millions in double charges between 2006 and 2012 for medications already covered by the national health plan, according to two separate research entities.
A recent study by the Center for Development Projects (CENDEX) revealed that health intermediaries have exploited loopholes in the healthcare system to charge exorbitant prices for drugs already paid for by the national Compulsory Health Plan.
The CENDEX study concludes that the double-billing scam cost the public $240 million between 2006 and 2012; however, the Colombian Medical Federation (CMF) says the magnitude of embezzlement is still unknown due to corrupt record-keeping by the intermediary service providers (EPS), which is in early stages of review.
“The existing magnetic information on [medication charges] does not correspond to physical documentation,” Dr. Oscar Andia of CMF told Colombia Reports.” Due to inconsistencies, we don’t know with certainty the true extent of redundant charges. It could be much higher.”
CENDEX has based its report on the magnetic information, provided to them by the Ministry of Health and health system’s financial administrator, Consorcio Fidufosyga. According to their study, the costliest double-charges were for the gastritis medicine omeprazole: in 2010 alone health insurance intermediaries charged the national health system over $10 million for a drug it had already bought.
Rituximab (Mathera), a drug used to treat various types of arthritis, also appears as one of the most frequently double-billed medications already included in the national benefit plan.
When will the public know the truth?
The Colombian Medical Federation has been in a lengthy legal battle to obtain the EPS records ever since it discovered the inconsistencies, but encountered heavy resistance from Consorcio Fidufosyga, who insisted at first that the information was private.
Finally, the Supreme Court ordered that all records and data related to redundant charges must be turned over and reviewed by the Ministry of Health.
Dr. Andina says that the ruling is being “partially complied with,” and the Ministry has begun inspecting the redundant charges made for Rituximab. However, the Ministry also warns that it lacks resources to the review of the sample of over 7,000 charges for 25 biotechnology active ingredients selected by the CMF.
Andina insists that if the Ministry fails to review these charges, the CMF will take action to see it is found in contempt of the Supreme Court.
However, he admits that “most likely there is insufficient physical capacity to review all physical documentation” and obtain definitive figures on the scam, which continued for over 5 years.
So far, the CMF has only been able to confirm that the health system was overcharged $10 million for antihemophilic factors VIII and IX.
Unable to break from the past
In 2011, Colombia’s largest private intermediate service providers was nationalized, and its directors were ordered to pay more than $700 million after fiscal authorities found public money had gone into investments that included golf tournaments abroad.
However, leading opposition senator Jorge Robledo recently said that Colombia’s largest health intermediary Saludcoop continues to misallocate hundreds of millions of dollars in public money despite the government take-over, estimating that at least $343 million has been used by the company to make payments on bank loans, purchases and leasing contracts.
- Medio billón de cobros extras (El Espectador)
- Interview with Dr. Osacr Andia, director of the Medical Federation Drug Observatory