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Suspenden el giro directo a la red de prestadores de la EPS Ecoopsos
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Esta semana la Superintendencia Nacional de Salud ordenó suspender de manera provisional el giro directo que realiza Ecoopsos EPS a su red de prestadores, teniendo en cuenta el riesgo actual que corren estos recursos del sistema de salud. Durante este tiempo se verificará que los valores presentados correspondan realmente a los servicios que se han prestado.
Esta medida se toma como consecuencia del seguimiento que se hace sobre Ecoopsos producto de la medida de vigilancia especial en la que se encuentra. La evaluación evidencia posibles riesgos en la operación de la EPS por acciones y omisiones de las obligaciones administrativas, por lo que los recursos del giro directo podrían estar en peligro.
Según el Superintendente Delegado para Entidades de Aseguramiento en Salud, Henri Philippe Capmartin Salinas, la EPS podría estar generando un mal uso de los recursos entregados, cuya destinación es específica para la atención de los usuarios del sistema.
¿Cómo se harán los giros a la red de Ecoopsos?
Por lo tanto, de ahora en adelante por cada postulación de giro, Ecoopsos deberá documentar, garantizar y poner a disposición del contralor designado por la Supersalud para el seguimiento de la medida de vigilancia especial, los siguientes requisitos:
- Para los contratos por capitación de atención primaria, informe en el que se relacionen los soportes que correspondan a las actividades ejecutadas y los expedientes contractuales. Posteriormente, se debe adelantar una verificación respecto de los RIPS que respaldan los servicios efectivamente prestados.
- Para los contratos de evento o cualquier otra modalidad, la metodología de giro autorizada para la red de prestadores y proveedores de servicios y tecnologías en salud.
- Facilitar al Contralor el acceso a los sistemas de información y la aplicación de la política de pagos definida por la EPS, conservando los soportes de las bases de datos que permitan verificar la radicación y auditoría de cuentas médicas.
- Para los anticipos otorgados a la red de prestadores y proveedores de servicios de salud y tecnologías en salud, que se paguen mediante giro directo, tesorería u otro mecanismo de pago, la aplicación de la política de anticipos otorgados definida por la EPS y el acceso a los sistemas de información que permitan verificar su desembolso y posterior legalización.
En este sentido, el contralor designado debe certificar ante la Supersalud el listado de prestadores y proveedores que cumplen con las condiciones requeridas para el giro de los recursos mediante las diferentes modalidades.
Artículo exclusivo: ¿Cuáles son las próximas decisiones más esperadas de la FDA?
Así mismo, el funcionario debe verificar la pertinencia en la aplicación de la metodología de postulación de giro aplicado por la EPS a su red de prestadores y proveedores, ya sea giro directo, pago tesorería, entre otros.
Finalmente, la Supersalud ordenó al representante legal de la EPS Ecoopsos realizar un proceso de auditoría a la totalidad de las facturas; realizar las acciones tendientes a la legalización o recuperación de anticipos y mejorar el seguimiento interno a la interventoría médica y financiera de la contratación, con el fin de garantizar la efectiva prestación de los servicios y la asociación de estos con la facturación radicada por los prestadores.
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