In a press conference issued this Thursday, June 6, the National Superintendent of Health, Luis Carlos Leal Angarita, spoke about the findings found in the three EPS intervened last April, EPS SANITAS, NEW EPS and EPS SOS
The Superintendent recalled the stages that are carried out during the management of the intervention. In the first, the intervening agents have the responsibility of making an in-depth diagnosis about the real state of each of these EPS and its impact on the health coverage of their members.
“It is important that today, in strict chronological order, the Superintendency presents to the general public the most relevant findings following the intervention of the EPS,” Leal emphasized, recalling that the diagnoses are the basis for the work plan that must be carried out. present the agents to correct any type of administrative error in benefits, guaranteeing the fundamental right to health of each of the people affiliated with them.
What was found at the EPS Sanitas?
The UPC is sufficient, or the expenditure resources are being used efficiently. At EPS Sanitas it was found:
- Increase in unjustified operating expenses, the balance sheet showed losses of more than 400 billion pesos.
- $104,226 million in operation of medical centers.
- There is no description and analysis of the affiliated population by social and economic conditions, quality of life, pathologies, risk factors and materialized risk. When this adequate characterization is not made, a plan cannot be carried out to influence the population to receive and have an adequate state of health.
- Extreme maternal morbidity ratio at 65 with a goal of 35, well above what is required by the norm.
- Payments for 64 lease contracts worth $4,666 million per month. $56 billion annually and improvements of $800 million in said properties.
- Weakness in RIPS reporting by service providers, low quality of data for audits.
- 76% contracts per event, contrary to its own manual.
- Rates contracted with own rates contrary to their manual.
- Medicines: Exclusive contract, prevents others from supplying, dispensing or supplying medicines, but allows the supplier to subcontract with other operators.
- Contract with the company “Andres Murcia Vargas Abogados Asociados” without any need, justification or benefit for the EPS.
What was found in Nueva EPS?
During the EPS takeover, 12,645,762 invoice records were discovered in the audit process for a value of more than 4.4 billion pesos, which had not been included in the financial statements totaling 5.7 billion, according to the comptroller firm. The existence of these records significantly increases the debt of the EPS.
The EPS made payments to health service providers without requesting reports on the care provided, especially in terms of health promotion and prevention. In the first quarter of 2024, the sufficiency of the network was 87.7%, with gaps of 12.3%, due to problems of resolution capacity, timeliness in provision and accessibility.
According to the guardianship and PQR accessibility report, difficulties in provision were identified in departments such as Cundinamarca, Antioquia, Valle del Cauca, Santander, Boyacá, Norte de Santander and Huila. Despite having contracted 100% of health promotion and maintenance care, coverage in specific programs for the year 2023 was low.
Medical spending in the New EPS increased by 58% between 2022 and 2023, due to adjustments in technical reserves, generating an accident rate indicator of 118.93%. The record of advances granted to EPS providers and suppliers presented inconsistencies, with invoices for advances since 2008 pending legalization in March 2024.
What was found in EPS SOS?
The auditor referred to the risk faced by the EPS due to the concentration of the primary level in a single provider (Comfandi), which is also a linked provider, which makes its efficiency evaluation difficult.
It was reported that in the PGP contracts signed with the provider COMFANDI, a low execution of 82.35% was recorded during the period from August 2023 to March 2024, equivalent to $19,629 million, along with low performance in previous periods of the contracts. without having yet made the corresponding recoveries.
Difficulty has been identified in recovering resources for services provided by other IPS and that were contemplated in the PGP contract, due to inconsistencies in the current contract. According to the EPS Audit area, the value to be recovered for the months of the current contract would exceed 14 billion pesos.
The National Superintendent of Health concluded that the findings require a much more in-depth analysis, which is why it will be evaluated together with the work plan presented by each intervener. “As the Superintendency we have the responsibility of verifying that this plan is fulfilled. “We are going to do everything to guarantee that health resources are used appropriately to protect people’s lives,” he stated.
