ASF disclosed 48 million pesos pending clarification in IMSS for alternative services
The federation supreme review (ASF) disclosed an outstanding amount to be clarified of 48 million 059 thousand 287 pesos in hospital replacement services IMSS. In many contracts, the supervisory body has identified inconsistencies in contracting procedures, payments, and deliveries.
In 2020, IMSS signed contracts with hospitals to take care of patients with COVID, illnesses, and other requirements. In 2021 he kept some contracts. ASF analyzed ten of these.
It was on April 13, 2020, when health institutions, including IMSS, signed a framework agreement with the National Association of Private Hospitals and the Mexican Hospital Federation, in order to provide beneficiaries and beneficiaries with medical and alternative hospital services, such as childbirth, pregnancy, postpartum care, cesarean delivery, pathology Appendicitis, hernia, gastric ulcer, endoscopy, etc.
On November 30, 2020, the members of the National Health System signed the second phase of the framework agreement with the Association and the Federation, valid from December 1, 2020 to May 31, 2021.
On August 11 of the same year, IMSS, individually, with the Association and the Federation signed a third phase of the Framework Agreement due to the increase in cases of SARS-Cov-2 disease (COVID-19), in which only Decentralized Administrative Operations Bodies (OOAD) Morelos were considered. and Nuevo León and Puebla, justifying this by the high demand for medical care in these entities.
What the ASF has found is that IMSS has not demonstrated that it has the controls, mechanisms, and systems in place, nor has it verified compliance with regulations to verify and monitor processes related to alternative hospitalization service contracting.
In addition, inconsistencies were found in contracting procedures, payments and deliveries. For example, among the contracts with numbers S1M00142, S0M0019 and S1M0038, corresponding to Star Médica, Sanatorio Psiquiátrico del Carmen and Casa de Salud, there were no supporting documents for the provision of services, in the payment files for 13 million 385 thousand pesos, 3 million 037 thousand pesos and 30 million 448 thousand pesos, respectively.
As for contract No. S1M0005, a difference of nine invoices, worth 1,619,000 pesos, was identified from the alternative hospitalization service from October to December 2021, which was not provided by IMSS.
Of the clinics and hospitals that reported alternative hospitalization under the Framework Agreement, it was determined that the OOAD Chihuahua Decentralized Administrative Operations Authority reported the expenditures of the Palmore Sanatorium totaling 1,187 thousand pesos, without being bound by the Framework Agreement or any legal instrument establishing a contractual relationship with IMSS.
In addition, 15 patient solutions requests were identified where the IMSS physician who requested and authorized them was the same as the treating physician at the sanatorium that provided the service.
On the other hand, the institute did not provide standardized information for patients who received alternative hospitalization service during 2021.
For all these facts, the ASF has issued three promotions imposing penalties for administrative liability so that the internal control body of the Mexican Institute of Social Security or its equivalent conducts relevant investigations and, where appropriate, initiates administrative procedures corresponding to offenses by public servants that can be committed.
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