Regarding the SOS, Leal clarified that “vertical integration is not complying with the standards within this EPS. Comfandi is the main shareholder, with power over 90% of EPS, SOS. The President of this entity was the same president of the Board of Directors of the SOS, hence he has the power to appoint many of its members to the boards of directors and this facilitated the contracting of almost the entire primary care network for this EPS took over its own IPS with multiple irregular findings in these hirings.”
According to the official, The contracts generated for primary health care alone were not providing the real benefits that users needed of Comfandi, because the goals achieved were very low, but 75% of the contracts were evaluated with a very low performance, no audits were generated“a review was not being carried out to ensure that the payments that were being made to each of the IPS for the provision of health services in primary care were meeting the quality standards or complying with the care agreed upon and paid for by the EPS. , that is The EPS paid without checking what it was payingwith a negative impact on the health of the population, but also with very high rates that were above the market average.”
In fact, the rates investigated as of today 2024 in the contracts evaluated between SOS and the primary health care provider network, which is owned by the same owners of the EPS, were at high rates and these contracts were concluded in 2022. What this means, according to the investigation, is that they are high prices for the date.
Likewise, the Superintendent of Health pointed out that 91.42% of the contracts were generated by the event modality, which is the most expensive within the health system, but when added together they cost the same as 8% of the rest of the contracts and “this 8% is the that concern us, because they are the primary care ones that have cost overruns, where compliance with the activities was not being verified and where the entirety was paid without making any reimbursement of the health resources that were not being executed by the providers. “They did not carry out the agreed activities that are paid in full, the agreed rates.”
Supersalud pointed out that between August 2023 and March 2024, the gap between what was executed by each of the IPS and what was agreed upon and paid by the EPS is above $19,000 million. In addition, with a clear redirection between the primary network with a four-level entity in Valle del Cauca, called Valle del Lili, where they provided medium and high complexity services.
“There is no rejection that the activities are provided in high-quality centers. On the contrary, it is excellent that the population can have a high quality, but There are services of medium complexity that can be provided on other types of networks and that would not generate such high costs for the system. like these, which are generated by a pact or a patient flow agreement within the system, which also generates administrative and geographical barriers,” explained Luis Carlos Leal.
He added that the network of contracted providers was insufficient; They had neither coverage nor screening for cervical cancer, the reports were late and the results were altered. Additionally, they had delays in the admission pathway to cancer care and delays in cancer treatments.
“The medication contract, which was carried out with Cruz Verde, had a modality where a specific amount was paid for each of the affiliated patients, regardless of whether or not the patient had the indication for medical treatment, con the seriousness that Cruz Verde never reported the delivery of all the medications and what type of medications it was delivering“Leal stated.
“A contract was made blindly where a fixed amount was transferred to a pharmaceutical provider, without verifying that the population actually had a benefit, even though this EPS had a high level of complaints about the timely delivery of medications,” he pointed out.
