2024-08-06 23:07:45
The Office of the Comptroller General of the Republic (CGR) carried out a Special Audit Action to analyze the use and destination of the resources of the Capitation Payment Unit (UPC) and the maximum budgets issued by the Administrator of Resources of the General Social Security System (ADRES) to the Health Promotion Companies (EPS) during 2020.
The objective was to evaluate the constitution and behavior of the EPS technical reserves, as well as their profits and changes in assets.
The EPS involved in this audit were:
Health Alliance EPS
Medellin Antioquia EPS SAS Savia Salud EPS Alliance
Anas Wayuú EPSI
Asmet Salud EPS SAS
Association of Indigenous Councils of Cesar and Guajira Dusakawi EPSI
Cauca Indigenous Association AIC EPS Indigenous
Emssanar SAS
Mutual SER EPS
Capital Health EPS S SAS
Capresoca E.P.S
Coosalud EPS S.A.
Ecoopsos EPS SAS
Invite EPS
Famous SAS
Mallamas EPS Indigenous
PIJAOS SALUD EPSI
Sanitas S.A.S.
Western Health Service SA (SOS EPS)
EPS SURA
MIA EPS Health Foundation
New EPS SA
Public Enterprises of Medellin ESP EAS
Total Health
Social Liability Fund of the National Railways of Colombia
For this evaluation, the CGR used information from the EPS financial statements for the years 2019, 2020 and 2021, certified by their legal representatives and statutory auditors, and registered with the National Health Superintendency.
Relevant Findings
Misuse of UPC resources: The EPSs paid for health services from periods prior to 2020 with UPC resources, for a total of $5.4 billion pesos, exclusively destined for purposes provided for in the Constitution and the law.
Prescribed debts: EPS SOS used surplus resources from the UPC 2020 to pay debts of $86 billion pesos from 2003 to 2015, when the obligations had already expired.
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Payments from previous periods: Nueva EPS paid $62 billion pesos from 2008 to 2015 with resources from 2020, while Convida EPS paid $4 billion pesos and Ecoopsos EPS $1,621 million pesos in the same period.
Money without evidence of use: In 2020, surpluses of $643 billion pesos were generated in Maximum Budgets, used to finance services not included in the health benefits plan, such as Capital Salud ($18 billion) and Convida ($7 billion).
Unsupported payments: Nueva EPS presented payments without support for $2.1 billion pesos and Famisanar EPS for $643 billion pesos.
Non-health care expenses: Nueva EPS allocated $40 billion pesos to expenses not related to health services, such as fees to board members, gasoline vouchers, yoga and pilates classes, and others.
Performance Results
The CGR identified:
61 findings with administrative impact.
37 findings with fiscal impact, for $6 billion pesos, giving rise to fiscal responsibility processes.
37 findings with alleged criminal and disciplinary impact.
24 findings for the opening of Preliminary Investigations, for $5.3 billion pesos.
37 findings with other incidents to be transferred to the National Health Superintendence and other competent authorities.
The report highlights structural problems in the General Social Health Security System, stressing the need for resources to be used exclusively for the provision of health services as stipulated by law.
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