2023-09-15 19:45:48
The National Health Superintendence ordered this Friday, for a period of one year, the forced intervention to administer the EPS Famisanar at the national level, following “evidencing the deterioration of its financial indicators, the growing number of complaints from its users and the failure to comply with more than 10 qualification standards that affect health insurance and the provision of services to its affiliated population.”
(Keep reading: EPS Guild proposes meeting with hospitals to clarify accounts).
The EPS has 3,049,712 members in 21 departments of the country, the majority of which are concentrated in Bogotá and Cundinamarca (77%), Santander (4.46%), Boyacá (4.34%) and Tolima (2.92%). %). It also has users in Atlántico, Bolívar, Caldas, Cesar, Huila, Magdalena, Meta, Nariño, Quindío, Risaralda and Valle del Cauca. In 6 other departments it has less than 10 members.
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The decision was adopted by the National Superintendent of Health, Ulahí Beltrán
López, following an evaluation of the performance of the administrative components,
financial, legal and scientific technical of the EPS, which led him to conclude that Famisanar “is not fulfilling its corporate purpose, has increasing difficulties in guaranteeing its members access to health services and has increased the risk of liquidity and insolvency for meet the obligations with its creditors in the short, medium and long term due to the increase in its liabilities by more than 140% since 2021.”
(You may be interested in: ‘We want to make a change together’: Guillermo Jaramillo, on health reform).
At the same time, the Superintendency appointed the financial administrator Sandra Milena Jaramillo as special intervening agent at the head of the EPS, who takes office today and must begin to comply with 14 orders given by Supersalud to guarantee the right to health of members.
High levels of complaints and lack of protection
According to Supersalud, this year the dissatisfactions of members of the EPS Famisanar are increasing progressively, reaching 59,391 requests, complaints, claims and complaints filed with Supersalud between January and June 2023.
When comparing the volume of complaints from the first half of this year with the same period in 2022, the entity verified that there is an increase of 24%, with the main reasons for complaint being the barriers in access to technologies and health services such as denial in the assignment of appointments or consultations, the lack of opportunity in the provision of health services and the non-recognition and payment of financial benefits.
In monitoring health indicators, Supersalud showed a 20% increase in the reporting of cancer cases in children under 18 years of age during the first four months of 2023.
Likewise, it recorded the notification of 6 cases of maternal mortality until epidemiological week number 20 of 2023, which does not show significant progress in the trend and compliance with the goals of the Deceleration Plan for the Reduction of Maternal Mortality.
Regarding the reason for being of the EPS, that is, the promotion of the health of users and the provision of services, Supersalud reported the recurrent non-compliance with health tracer indicators such as early recruitment to prenatal control, which in turn, it is related to the high incidence rates of congenital syphilis.
According to the information reported by the EPS Famisanar during the on-site audit carried out by Supersalud, the most frequent reasons why protection actions are presented are the inopportunity in assigning appointments for specialized medicine and the late delivery of supplies, devices or medications necessary to guarantee comprehensive health care for the population.
For the audit, the EPS presented inconsistencies in the information related to the protection actions, which makes inspection and surveillance actions difficult, since records were found from what was delivered that do not specify the reason for filing.
Inconsistent financial reporting
Supersalud announced that in the evaluation of the financial component of Famisanar, the information shows a high risk of insolvency and inconsistencies and lack of clarity and transparency were documented in the reports delivered.
Some conclusions from monitoring the financial issue are:
• In December 2022, the EPS recognized liabilities from previous periods for $758,671 million. The above implies that the result of the Investment Regime indicator at the end of 2021 was overvalued; That is, if the EPS had recognized in a timely manner, its liabilities would have presented a greater non-compliance in the indicator at the end of 2021.
It is concluded that the EPS Famisanar repeatedly reported inconsistent information to Supersalud, with failures in quality and transparency, which prevented the exercise of inspection and surveillance functions and is framed in non-compliance with numeral 11 of Article 130 of the Law. 1438 of 2011.
(Read also: EPS receives a million-dollar fine from Supersalud, for ‘violation of rights’).
Between December 2021 and June 2023, Famisanar presented a 4% reduction in the value of assets (-$44,123 million), an increase of 142% in the value of its liabilities ($1,296,597 million) and a capital variation of -918 % (-$1,340,720 million), so that, as of June 2023, its total assets ($1,010,484 million) were equivalent to only 45.7% of its total liabilities ($2,209,623 million), a situation that has high liquidity and insolvency risk to meet obligations with creditors
in the short, medium and long term.
According to data from Supersalud, the EPS Famisanar, at the end of the 2022 period, presented an accident rate of 119%, that is, for every $100 it received, it spent $119, an indicator that would be of dubious reliability due to the untimely recognition of accounts payable and costs for Technical Reserves for $602,370 million.
Finally, according to the monitoring and evaluation of Supersalud, the EPS failed to comply with the provisions of decree 2702 of 2014 by making insufficient efforts to
capitalization to offset the losses recorded in 2017, 2018 and 2022.
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