Colombia uncovers scandal in the health system: $2.3 trillion billed to deceased persons

Bogotá.— The Administrator of the Resources of the General System of Social Security in Health (ADRES) revealed to the Constitutional Court a report that uncovers one of the most serious frauds in the recent history of the Colombian health system: between 2018 and 2023, more than $2.3 trillion were billed for medical services provided to 471,480 deceased people. The finding, presented as part of the review of the Payment per Capita Unit (UPC), highlights a systematic practice of irregular charges that compromises the financial and ethical integrity of the health system, both in the contributory and subsidized regimes. According to the document, the year 2021 concentrated the highest amount of undue billing, with $699.480 million registered. The contributory regime represents 52% of the total value, which demonstrates that irregularities affect both the public and private sectors. The most surprising thing: medical services were reported up to 26 years after the death of some patients. The report directly points to several of the main Health Promoting Entities (EPS) in the country:

• Sura: 50,404 cases – $684.989 million
• Compensar: $418.970 million
• Savia Salud: $261.580 million

A particular case involves Coosalud, which would have reported the care of a patient 26 years after his death. The report details that 31.21% of the records correspond to services reported between 2 days and one month after death. 4,666 people "received" medical attention more than a year after they died, while 1,172 cases exceed 10 years after death, and 29 cases show reports more than 20 years later.

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Medical procedures concentrate the majority of the fraud, with 382,864 records and an estimated value of $1.6 trillion, followed by hospitalizations, laboratories, and prevention programs. The law stipulates that EPS and IPS can only bill for services actually provided up to the date of the patient's death, and must report the death notice within a maximum period of five business days. Despite this, ADRES data shows a massive omission of controls and audits by the entities.

Government's Reaction

President Gustavo Petro described the case as a "matter of extreme gravity" and warned that the finding demonstrates the urgent need to reform and cleanse the health system. The report has already been sent to the Constitutional Court, which is analyzing the results within the framework of the review of the UPC, the mechanism that defines the financing of health services in Colombia.