The cobra's bite to the health of the most vulnerable

The corruption network imposed bribes of up to 35%, diverting a substantial part of the resources allocated to healthcare Hemodialysis billed to deceased individuals, vaccines from the Expanded Immunization Program charged as if they were private, oncology treatments inflated with unnecessary chemotherapy and radiotherapy sessions. Operation Cobra documents a network that would have diverted more than RD$15.921 billion from the National Health Insurance, the public insurer that guarantees medical care to millions of vulnerable Dominicans. The Public Ministry's file also includes medical authorizations that the affiliates themselves claim to have never received and, in some cases, gynecological consultations registered in the name of men.

The structure from the top

The accusation indicates that the scheme was orchestrated from the Executive Directorate of SENASA by Santiago Marcelo F. Hazim Albainy, then director of the entity. Under his management, the PEPCA maintains, a coalition of officials was formed that took control of the contracting and payment processes, displacing technical criteria to favor specific economic interests. That core includes Germán Rafael Robles Quiñones, a legal consultant identified as a recipient of bribes; Gustavo Enrique Messina Cruz, a former financial manager attributed with manipulating accounting records; and Francisco Iván Minaya Pérez, a Health manager linked to the validation of contracts without fulfilling requirements.

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One of the key mechanisms was the creation of a Medical Contracting Committee without legal basis, which concentrated decisions on providers and special programs, allowing the discretionary allocation of contracts within SENASA.

30% Bribes and Million-Dollar Contracts

The Public Ministry identifies as the central axis of the scheme the demand for bribes equivalent to between 30% and 35% of the payments made by SENASA to the contracted companies. In the case of Nutri-Med CAS, Nutrición & Medicina, SRL., linked to the accused Cinty Acosta Sención, the accusation alleges that the company paid bribes for more than RD$1,165 million. Part of those funds would have been initially channeled through intermediary companies such as OGSS Prestadora de Servicios de Salud SRL., and subsequently delivered in cash to Germán Robles Quiñones. Also charged is Ada Ledesma Ubiera, linked to Lufarca SRL, a company that allegedly received more than RD$38 million and is noted for transfers and payments identified as commissions and advances within the framework of the investigated operations. Lufarca also appears as an intermediary company associated with the channeling of payments and additional contracts with SENASA. Another relevant axis was the Read Group, made up of KHERSUM, SRL, DELESTE, SRL and FARMACARD, SRL., represented by the defendant Eduardo Read Estrella. These companies concentrated primary care and telemedicine contracts under capitation payment, guaranteeing fixed monthly income. KHERSUM alone received up to RD$65 million monthly, in addition to an additional RD$5 million for telemedicine. However, an audit determined that only 4.2% of the subsidized population contracted received care, resulting in millions in payments without the effective provision of services. The bribes associated with this axis would exceed RD$1.621 billion between 2020 and 2025.

Special programs as a bypass

The investigation describes the use of special programs as a mechanism to channel public resources. These include Nutrisalud SENASA and the Senior Nutrition Program, managed without sufficient technical support according to the record. In the case of Nutrisalud, the Public Ministry points to Flavorheart Food Parts SRL, represented by Heidi Mariela Pineda Perdomo, a company that, according to the Comptroller General of the Republic, did not have sanitary authorization as a medical office, despite receiving payments exceeding RD$1,606 million. These programs diverted funds to people outside the established age range, allowing the distraction of at least RD$272 million. In the program aimed at older adults, SISALRIL also found the absence of clinical follow-up analytics, despite the delivery of nutritional supplements to a vulnerable population.

Accounting cover-up

The sustained outflow of resources was concealed through the manipulation of the Bordereau, SENASA's internal record of outstanding payment obligations. The accusation attributes to Gustavo Messina Cruz the instruction to close this record monthly at predetermined amounts, undervaluing thousands of authorizations. Upon correcting these distortions, an internal commission and an external financial advisor detected a hidden deficit exceeding RD$14.34 billion that had not been reflected for years in the reports sent to the supervisory bodies, compromising the financial stability of the public insurer.

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Non-existent services and defrauded affiliates

The file documents direct fraud against members, such as billing for services not provided and medically unnecessary procedures. Audits carried out on providers such as Grupo Siulrod SRL, linked to Ramón Alan Speakler Mateo and Rafael Luis Martínez Hazim, revealed that 100% of the contacted affiliates denied having received the services charged to their policies, including authorizations incompatible with their gender or medical condition. In addition to this evidence, there are the findings of SISALRIL and the Comptroller's Office, which detected contracts without health authorization, undue payments, and serious failures in clinical controls.

A developing case

According to the Public Ministry, the accusation is supported by documentary, expert and testimonial evidence, including bank transfers, fictitious invoices and statements from employees and defendants. Among the assets acquired with triangulated funds, the purchase of a Lincoln Navigator jeep, prior to the official appointment of Hazim Albainy, and a Rolex Daytona watch valued at USD$83,000, acquired through transfers channeled through intermediary companies, are documented. The Cobra Operation continues in the judicial phase. Criminal responsibilities will be determined by the courts. The institutional consequences, however, are already being considered: a system created to protect the most vulnerable Dominicans would have been used, according to the accusation, as a means for the systematic diversion of resources that should have guaranteed their health.