According to reports of alleged transitions and bribery in the provision of prosthesis in IOMA disclosed in the framework of the investigation Implant files, was signed on Thursday by the social work directory of the state of Buenos Aires Creating a new supplier register to be launched in February, it ethey will limit brokers in order to reduce costs and be publicly consulted. It will start by providing prosthesis and internal internal life, and then continue with other benefits.
This was announced by IOMA President Pablo Di Liscia, who tried to take this decision away from the impact of the investigation carried out by the Argentine team International Consortium of Investigative Journalists (ICIJ) which constitute Infobae, Nation in Profile He said that "work has been carried out in this field since March, and that several administrative and control cases have taken place".
An official who took over the leadership of Cambiemos in December last year as the third holder of IOMA, denied the existence of surcharges in the IOMA prosthesis nomenclator. Prices above market values were which were reported by several consultants z Argentinian team ICIJ, within bribes charged by medical staff of IOMA to place prostheses of a particular orthopedic or supplier company. These unlawful payments were also apparent in the audio talks between doctors and providers.
After the explanation that "They are not IOMA doctors"because they do not directly employ social work, but sign agreements with circles and associations that bring together health professionals, Di Liscia said that IOMA"not only did they not confirm these practices, "but were" proactive in criminal complaints"
Given the details provided by the agencies, Since March 2016, 27 players have appeared in courts, mostly against IOMA providers . These denials relate to specific cases, not to what many warn practice involved in social work. The official stated that they had also begun 250 administrative procedures against employees, contractors, doctors and suppliers; 44 IOMA providers suspended; and disappointed 14 others.
They also reported on the practice of illegal payments requested by doctors patients online channel for reporting irregularities which was enabled in January this year. IOMA reports that they received something 300 complaints in this way.
According to the sources of the provincial government, the governor María Eugenia Vidal "asked for everything that could be managed in a transparent manner, given that we came from the year of Scioli, where IOMA was suspected everywhere". They have been assured that "they are aware of the changes DiS has implemented in this regard" and added that the Governor "meets with the continuous monitoring of IOMA management, as well as with the other agencies and ministries".
Di Liscia assured Infobae, also negotiations are still open with doctors' associations for the implementation of the new nomenclature of professional practices and the updating of fees that doctors who provide services for IOMA are charged. Experts claim that it is obsolete – originated in 1958 – and require them to increase costs for any medical practice.
Overpriced in the debate
In August last year, National Vice-President Graciel Ocaña accused the IOMA peacekeepers of bribes paid by social workers to choose their products before the Institutional Strengthening Office (OFI) of the province of Buenos Aires.
"This maneuvering of donations could not be carried out without the override of doctors, but not without the involvement of IOMA bodies charged with fixing the prices set out in the nomenclator, which are always well above the market prices. Without this condition of fraud, it would not be feasible"said the deputy.
Testimonials of suppliers they collect Infobae coincided with the fact that the price set in the nomenclator "included" the bribe that the provider must pay to the doctor. He also came from a new audio that he released Infobae this week,
In her complaint lodged by the OFI Justice, Ocaña gave comparative examples of the values of certain prostheses in the IOMA nomenclator and its costs on the market. According to these prices, IOMA paid in 2016, 2017 and until August 2018, more than 500% of the value of the prosthesis.
In the same vein, Idelmar Seillant, president of the IOMA Association of Experts (APIOMA), which brings together about 400 employees in social work, confirmed that the denture carrier agreement signed with providers in 2016 had "values between 100% and 700 % higher than the market, in order to support the entrepreneurs of the amounts of millionaires who then paid to IOMA officials. "
However, IOMA denied additional payments. "The value of a complaint with a reality can not be verified"said Di Liscia." The first thing we did to take over the new administration was to close the tap. One day, before leaving the IOMA address, on December 9, 2000, the previous administration set a price increase between 35% and 50% for the dentist, retroactive until October 2014. Leave this without effect, lower prices and redistribute the nomenclator with a 20% discount"He explained that it was a later triggered dollar" and did not offer some prosthesis because the bidders did not want to sell at prices in 2016, 25% updated for imported prosthetics (except for Mercosur) and national ones. "
Di Liscia also Relativize the rejection of the doctors' prosthesis, without being properly justified, and the request for the second prosthesis of a particular companyto accept the payment of a bribe to sell its product to IOMA.
This practice was reported to the injured bidder by the OFI, and it was also exposed in the documentation and audio-visual services that it agreed to Infobae. "Several times, a doctor chooses to orthopedics because he participates in surgery and offers a set of instruments, and every orthopedic has his own specific prosthesis, so the logistical agreement between the doctor and the performer takes place before surgery," he argued. .
However, he acknowledged that "these are IOMA health auditors who need to analyze these rejections" and that "we still need to improve a number of mechanisms"" The more they grow in the audit, the more we will improve it. We need methodological changes and informatization of information"IOMA has between 300 and 350 health auditors and serves two million branches in Buenos Aires.
Di Liscia explained this in the new register of suppliers They will strengthen denture suppliers, orthoses and accessories to eliminate intermediaries – distributors and resellers – and buy directly from manufacturers. "It will be designed for IOMA, which will pay 20% lower price and improve the quality of suppliers and eliminate those who sell poor quality," said IOMA, the first buyer at the provincial and other national level, according to PAMI.
Addressing the question of the potential risk that the market is too concentrated, he said that "it will be sought out that there are no unique suppliers, so as not to form a monopoly and provide greater offers"IOMA stressed that" there are currently suppliers who stating in stock without dentures and cause the operation to be postponed. This would not happen with the producers. "
The IOMA budget for this year is 44,000 million pesos. Of this, 5.6% is spent on prostheses, about 2,500 million, intended to buy about 50,000 prostheses. About 6% was carried out outside the nomenclator, that is, by price confirmation.
Today, the largest social work in Buenos Aires is about 500 prosthesisers, orthoses and accessories, following talks by the Argentine Chamber of Occupational Therapy, Implants and Medical Equipment (CADIEM) "80% of prostheses IOMA can buy could be covered by 20 major manufacturers or distribution chains The remaining 20%, because they are specific, would cover 20 or 30 other suppliers. "
According to these calculations, they estimate that in IOMA suppliers in the new register will range from 50 to 100, national and foreign producers who market their products in the country.
A new register of suppliers would be implemented in February. "This will also mean greater transparency in purchasing and new general terms and conditions for suppliers, such as the requirement for a guarantee relationship (in order to ensure IOMA can carry out mutates in the event of incompatibility) and scoring (assessment based on compliance with the contract) will fix a temporary or permanent cessation of registration, "adds Di Liscia.
Registration -poved- This will be a public consultation online. "This is part of the process we are dealing with digitize information. When we arrived, almost everything was processed on paper, "said the owner of social work. As part of the situation they found, it states that "IOMA had 160 systems of unrelated applications for recording information and 23 different affiliate registries."
Manufacturers are under suspicion
However, the direct conclusion of contracts with producers does not provide for the removal of disputed practices, as several international companies selling their products in Argentina recognized in the United States bribe doctors and officials to sell their products in the local public health system.
"We will sign agreements compliance, which means that contracts can be revised and we are looking for manufacturers to oblige themselves to comply with the rules, "Di Liscia responded when the Argentine team ICIJ asked the question.
World Investigation Implant files that two of the foreign manufacturers who participated in IOMA's new registrations were among the ten most adverse effects on their medical devices, reported by the US FDA in 2017. For example, Johnson & Johnson had 99,179 adverse effects last year and ranks third. Abbott followed him in fourth place with 69,007 adverse effects.
The other outstanding debt, recognized by the IOMA holder, is update nomenclator of occupational practices in private sanatoria that attend IOMA patients or in private offices. Although it seems amazing, despite the progress of medicine, it is present 1958
"For ten years we have offered the IOMA Nomenclature of Practices and Fees agreed with the scientific associations of each specialty." All the IOMA Presidents whom we met, including the present, they told us that it is necessary to change the nomenclature, but Then they say that a cost study is necessary and there is no progress. There is no political will to resolve this issue, "notes Eduardo Martiarena, head of the agreement on independent medical associations of Buenos Aires (CEMIBO), which brings together seven medical associations from the provincial capital.
This outdated type of activity affects the fees that have already been postponed. "As a denominator, practices that are no longer performed and are even contra-indicated, and much more modern, are not foreseen. We need to transform ourselves into liars on account, force us to misrepresent the reality in order to be able to adjust the code for behaviors that are not envisaged"added the orthopedic surgeon.
Request a fee
The request of health associations includes reallocation of fees. "You need to update the nomenclator to charge what is appropriate. If there are supplements on the dentist, we want to help the system to review and optimize the costs so we can charge what we need to charge. The system can not continue and does not work we can not continue working in this way"says Martiarena.
IOMA is negotiating fees from two federations that combine different circles of doctors, the Medical Association of the Province of Buenos Aires (FEMEBA) and the Medical Association FEMECON Conurbana). It also has agreements with seven other health associations in the most important cities of the province.
One of them is Medical Association Platense. "We want to a transparent system of practices and the provision of prosthesis that IOMA should use for what it needs to spend: physicians who are human resources. We ask IOMA modernization of fees of 30%"says its secretary, cardiologist Patricio Flaherty.
Depending on the current values of the nomenclator, with traumatic surgery of the ribs, clavulas, patella or breastbone, traumatologists charge IOMA between 1,700 pesos and 2,900 pesos, depending on the length of service and degree of specialization. And for those who include pelvis, femur, tibia or fibula, charge between 4,800 and 8,300 pesos.
According to Flaherty, IOMA terminated the negotiations. "There is no call with the exact date of the organism to discuss the issue of the nomenclator, we started this topic for three months, we presented a proposal that we drafted in October from various scientific societies, has been accepted, but not yet established."
The Social Work of the State of Buenos Aires denies that "the negotiations have been suspended. "We believe that today's pay needs to be adjusted, but require a 30% increase, which means that all IOMA benefits will increase by 30%," they warn.
Di Liscia with Gustavo Gimenezo, Mar do Plato Doctors' Association
Accordingly, Platense Medical Association appoints associations of doctors and scientific societies of various specialties at a meeting to be held next Tuesday in which it will "analyze what measures to be taken." They do not exclude the termination of benefits as professionals.
The complaint by Ocaña for bribes, charged by IOMA healthcare providers, was carried out by the DFP to the Silver Justice and fell to Prosecutor's Office no. 6 Marcelo Romero. Among other evidence, this prosecutor sent a formal letter to IOMA on November 5, requesting a list of prostheses acquired in the last five years, the doctors who requested them, the rejected, the reasons and the conclusion of the auditors as a list of providers.
The Agency's lack of response was repeated by the applicant last Thursday, and as he said Infobae, received the IOMA legal area yesterday. In social work, he did not want to owe the information or documentation required by the judiciary.
This week, a witness, accompanied by an OFI lawyer, called the Public Prosecutor's Office to testify on bribe requests from IOMA healthcare providers for prosthetics providers.
Romero asked to see the cause that is in Prosecutor's Office no. 2 La Plate, in charge of Betina De Lacky, where a previous complaint by the OFI came in June, which did not make much progress in these months. The complaint was made on the basis of data that approached the person who requested a reservation of identity, about 20 similar cases of doctors who participated in these maneuvers. The preliminary investigation of the OFI includes statements from at least six patients affected by this maneuver, which delayed or temporarily suspended their operations, or in one case the patient had to pay for his prosthesis from his pocket.
The accusations by Ocaña and OFI are not the only ones in this field in the judiciary. Since 2011, Seillant has nearly thirty complaints from the United Trade Union of IOMA Experts and Technicians (SUPTTIOMA) for Corruption in Previous Efforts. The last ten start in 2016. It is also very critical of the current management, accusing the persecution of APIOMA and its trade unions. "I want to Ask the governor to renounce the current authorities because they are the accomplices of corruption and are reviewing the court. We offer APIOMA experts and a documentary about which we have collected about irregularities, "he said Infobae.
"APIOMA brings together about 400 professionals, including 70 auditors, and we do not defend the defective auditor," he said. This week he gave a new judicial hearing, as he ensured that IOMA pays auditors that the judicial authority ordered the reintegration. SUPTTIOMA, the Presiding Member, is registered but does not have a union status recognized by the Ministry of Labor.
Idelmar Seillant, president of APIOMA and his association SUPTTIOMA
In line with the above, it will submit another complaint on Monday, in which, according to the most recent analysis carried out by APIOMA from January 2016 to October 2018, 4,800 million pesos, which were overpaid in IOMA for additional duties companies that would be linked to officials and trade unionists of the UPCN, a guild that is strong in the social part of the province and encountered by SUPTTIOMA.
Argentine team of the International Consortium for Research Journalism, in which it participated Implant files integrated by Mariel Fitz Patrick (Infobae); Maia Jastreblansky, Iván Ruiz and Ricardo Brom (La Nación); Emilia Delfino (Profile) and Sandra Crucianelli (for Profile).