The agency, which since last Monday is under the purview of the Superintendent of Health Services (it used to be a decentralized body), "its main objective is to manage the resources of the Solidarity Redistribution Fund". The public health care sectors will ask APE for "financial support to offset the costs of treatment of high economic impact, provided that they are within the medical-assistance benefits in their coverage."

To get an estimate of how much money the agency handles the AGN noted in its report published today, that between 2005 and 2010, "the administration paid a sum of $3,649,374,850" to the health care sector.

How does APE Give Money to Health Care?

In order to receive funding, public health care provides APE with the necessary documentation for the effective delivery of health services. These records enter the Bureau through Entry Administration, there are "between 350 and 400 per day." In this regard the AGN noted that "staffing is insufficient for the accumulation of existing work."

Financial support is provided through grants, refunds, or some exceptions: In the first case, the money was given to the entity before the medical services were provided (this mode was terminated in early 2008, except in those cases where there is a chance of death); in the second manner, payment was given after the execution of the medical practice. In those cases of exceptions, as its name suggests, are applications of health care outside the regulatory framework for covered conditions, "and can only be approved by the highest authority of the organization."

Control? Of The Records

The watchdog said that the order of arrival of the documentation to the Entry Table "is not always chronological." The report adds that "as the referral of the file, which goes to a technical analyst who then evaluates the request for funding is "manual”, discretion in their treatment is feasible."

In addition, they found "a huge amount of files being processed, i.e., that were waiting to be analyzed, due to the large number of files per day that enter a low number of analysts." To this, we must add "the limited physical space that causes problems with the collection and management of delayed documentation."

The audit work, which focused on assessing the period 2005/2010, stressed that in APE "they do not verify the accuracy of the data from the medical care auditor, or if providers are enrolled in the relevant Register" because the only matter they control "is if both documents are attached to the file, as is stated in the regulations." To put it more clearly, "around 44% of doctors were not registered with the Superintendence" while "nearly a third of providers had expired permits".

During the analysis of the files submitted for financial reimbursement, the watchdog found "questionable legitimacy dies." From a sample of 45 cases there were 12 cases in which laboratories "could not certify as legitimate by differences in typography, printing, or the cardboard used." However, they stated that "because there aren’t any examples of the real die" only in four cases could they "certify illegitimacy."

In some records, the AGN "doubts about the authenticity of the documentation" that allows refunds for benefits mainly because of the "similarity of signatures, various types of recipes, prescriptions, and receipts." Of 346 cases of beneficiaries with disabilities, whose documentation the Audit had access to, over 70% "didn’t have a certificate issued."

On the other hand, the audit found that there wasn’t documentation in each file that would show "the patients’ medication or health care provider", or "three different budgets from suppliers or service providers that would present the necessary elements to define the maximum financial support they could provide." It should be noted that "Internal Audit Unit was never enabled or occupied."

Another noteworthy result was the result of crossing information between the PAMPA system data base (where all the information is being recorded) with the pattern of deaths from the National Registry of Persons, "there were 117 beneficiaries who had died but had coverage after their passing."

Accountability

The National Audit noted that prior to providing financial support; the Special Programs Administration "did not check whether the public health care sector owed subsidies." In this regard, the AGN evaluated "outstanding renditions of subsidies or recoveries for benefits that were not provided" and, according to the records of the Entity, between 1999 and 2010 "the outstanding balance of $689,027,542.72 pesos" amount that represents "57% of the benefits paid." To this situation we must add that “a history of sanctions to Health Care Workers" was not detected.

Chronic Diseases

The AGN stated in its report that balances disbursed by the EPA to address some chronic diseases, such as HIV, hemophilia, and disability, "due to the characteristics of chronic diseases the expenditure should be more or less constant". However, the auditors identified "significant fluctuations" from one period to another." There is a notable increase in the amounts for 2006 and 2007, a small decline in 2008. But if we compare disbursements to health care during the same period we can see big differences.

In relation, the watchdog found "no cause to justify this behavior," and that "there seems to respond to a massive change of health care" or "a statistical or epidemiological reason."

How The System APE Uses Work?

The PAMPA "is the quintessential tool that supports the management of all the actions generated in APE." However, the AGN found that "there is a lack of control and appropriate processing of functions, therefore the accuracy and integrity of the data is affected." Meanwhile, "fields are empty or incomplete, errors in loading dates and amounts, duplicate records" that manifest "a lack of reliability of the information recorded".

The auditors made a request to 467 benefit recipients funded by APE to verify that they have received the appropriate treatment, but "in 116 cases, they could not be reached because the contact information of the system was wrong."

Meanwhile, the audit found "inconsistencies in the amounts recorded in the system that affect the balance: amounts requested below those granted, amounts paid less than the higher figures rendered and paid."

The Neverending Story 

The Office of the Comptroller General (SIGEN, for its acronym in Spanish) had warned in 2006 some of these issues, although the AGN "could not see an improvement in the situation it did increase because it grows proportionally to the increase in operations."

In 2005, the federal watchdog had evaluated APE finding some of the shortcomings that are detected once again in this opportunity.