Colombia’s Prosecutor General’s Office opened up two new criminal investigations into irregularities in the provision of medical care and mismanagement of funds administrated by the government agency Fosyga, W Radio announced Wednesday.
The prosecutor general and the National Police have begun an investigation into the legal representatives, partners and other employees from 15 healthcare providers (IPS).
The hospital and doctor’s office employees allegedly received money from Fosyga for medical services that were never provided to patients.
According to preliminary investigators, these irregular IPS institutions, known as “paper companies,” have been operating since 2004.
In the second investigation, the Prosecutor General’s Office is looking into the alleged criminal activities of a number of health insurance (EPS) companies. These EPS companies reportedly provided healthcare to ineligible recipients.
According to the prosecutor general, the EPS companies illegally collected social security funds for recipients (mostly state employees) already covered by a special healthcare plan. The EPS companies, reportedly aware that the patients were doubly covered, are believed to have embezzled the surplus funds.
Several officials from the various EPS companies, as well as from the Ministry of Social Protection and Fosyga, are already the subject of current investigations.
Payments requests to Fosyga and the Ministry of Social Protection made by five other EPS companies, Salud Colpatria, Coomeva, Ecopsos, Famisanar, and Solsalud, were also found to be fraudulent.
There were multiple cases of “dead people receiving benefits, monumental budget overruns and people successfully petitioning for a health service to be funded, but never receiving the money because it was kept by middlemen,” said Colombia’s President Juan Manuel Santos in May.
Investigators determined that Fosyga reimbursed the EPS payment requests without proper consideration, receipts, or any official letters.
In some cases, payments were supported by claims with names that did not coincide with that of the patient. Other claims were for people who were not even affiliated to that particular EPS and in certain instances the medication authorized did not reach the patient.