Authorities have confirmed a pattern of fraud and abuse in the Electronic Medical Orders (OME) system, leading to criminal complaints for fraud, document forgery, and defrauding the public administration, officials revealed to NA. «The objective is to protect the resources of retirees and ensure that every peso is used for real and quality benefits, not for maneuvers that distort the system,» they stated. These are serious cases in which medical providers, clinics, and pharmacies took advantage of the electronic system to bill for services never performed, issue fake prescriptions, or manipulate the identities of beneficiaries, official sources specified. They also added: «There are at least six active judicial cases driven by the Institute and PAMI's Federal Prosecutor's Office before the Federal Justice system, filed in different jurisdictions of the country». Among these, the following stand out: providers that generated non-existent medical orders and billed for practices never performed; repeat offender companies that, despite warnings, continued with a systematic fraud scheme for months; doctors who issued irregular orders using their professional user accounts without backing from effective care; pharmacies that dispensed fake electronic prescriptions to third parties, defrauding the Institute and beneficiaries; medical centers where manipulation of records and sharing of professional credentials were detected. «This administration has committed to ending attempts at systematic fraud, the simulation of consultations, document forgery, improper use, and violation of the traceability system. Audits identified the excessive use of services by various medical professionals, and before the Public Prosecutor's Office, the corresponding criminal complaints were initiated,» the agency stated in a communiqué. It also added: «These could constitute illicit acts, giving rise to possible acts of defrauding the public administration and negatively affecting the correct management of public resources derived from the contributions of beneficiaries». Within the framework of another measure that deepens controls, the Institute is updating the medical care supervision and traceability system, which includes exhaustive monitoring of service thresholds, the mandatory use of the PAMI appointment system, and a permanent audit of the provider's conduct based on their declared service capacity in a specific specialty. «The new measures have already begun to be applied and foresee administrative and criminal penalties according to the level of deviation detected,» they clarified and stated that «care for the beneficiary is guaranteed at all times». Any excess or irregularity will be penalized according to its level of deviation, PAMI stated. According to what the Argentine News Agency was able to ascertain, the agency «detected and denounced a series of irregular maneuvers in the electronic medical orders system, ranging from the simulation of consultations and billing without backing to document forgery and the improper use of personal data of beneficiaries». The National Institute of Social Services for Retirees and Pensioners (INSSJP) has deepened controls over the actions of PAMI providers due to serious irregularities detected in the electronic medical orders system, billing without backing, and improper use of the personal data of beneficiaries. «These actions seek to generate greater control and rationalization of spending based on the updating of the service capacities of providers and new guidelines for the application of differential value thresholds».
