The Colombia´s Attorney General Office reports that, in a joint investigation between the Presidency of the Republic of Colombia and the National Police Dijin team, five warrants of arrest issued by a Supervisory Judge against executives and former executives of the health insurance company “Nueva EPS” were put into effect for the offense of fraud in health sector.
Arrests were ordered within one of the prosecutions which are conducted by the Attorney General Office – National Anti-Corruption Unit, PAS subunit, for the existence of possible irregularities in 41.138 recoveries for medical procedures and medications not included in the mandatory health Plan “POS”. In this case, according to the investigation, between August 2008 and December 2012 a number of recoveries were irregularly carried out to the “Solidarity Fund and Guarantees” (Fosyga), in an amount that the Prosecutor’s Office estimated at least ten billion pesos (10.000.000.000).
The main method used by the EPS to defraud the system consisted of altering the Scientific Technical Committee documentation. As it is known in Colombia, when ordering the payment of a procedure or medicine not included in the POS through a writ for protection of fundamental rights, the health system must recognize to the EPS a value between 50% and 85%. If the order is through Scientific Technical Committee, the recovery may be 100% of the cost of the procedure or medicine.
In these cases, when the EPS had learned of the existence of an order issued by a judge in charge of the writ for protection of fundamental rights in order to deliver a drug or to perform a medical procedure, the EPS irregularly amended documentation of the Scientific Technical Committee to make believe that the procedure had been authorized by that entity, which obtained irregularly payment by 100% and not for a value between 50% and 85% as it would be in accordance with the regulations.
The investigation began in July of 2012 as a result of the application of a principle of opportunity for people who were arrested due to the so-called ‘carousel of health’ during the first phase of the investigations.
In order to conduct the investigation, criteria concerning prosecutions prioritization and criminal intelligent pursuit was applied by Colombia’s Attorney General Office, through a special group of prosecutors, assistants and judicial police members highly specialized in these issues that was formed to attend to the investigations exclusively aimed to the health sector.
In press conference, the Colombia´s Attorney General, Eduardo Montealegre Lynett and the Anti-corruption and Transparency Secretary of the Presidency of the Republic, Carlos Fernando Galan Pachón, they explained that the results in this case are an important step forward in the fight against corruption and in the process of identification of those responsible for the embezzlement to health.
The arrestees are: (i) the Vice-President on Health of the Nueva EPS, (ii) the Manager of Recoveries and Medical Accounts of the Nueva EPS, (iii) the Operations Manager on Health (for the time of the facts), (iv) the Coordinator of CTC (Scientific Technical Committee) and Writs for Protection of Fundamental Rights of the Nueva EPS, and (v) the Coordinator of CTC (Scientific Technical Committee) and Writs for Protection of Fundamental Rights of the Nueva EPS (for the time of the facts).
These people will be presented before a Supervisory Judge in order to make legal their arrests and charge them with counts of falseness in private document, procedural fraud, and aggravated fraud, in consistent sequence of serial crimes.