After complaints against more than 300 doctors, Consalud evaluates new legal actions for irregular issuance of licenses

With the filing of 187 complaints against foreign doctors who have large volumes of medical licenses issued, Consalud this week was at the head of the isapres offensive for this cause before the Courts of Justice, adding to date legal actions directed towards a total of 309 doctors.

The latest action carried out together with the company ALTO Inmune, is the third of its kind promoted by Consalud after two series of complaints finalized last year: the first against 27 Chilean specialists profiled as large issuers of this instrument with the Association of Isapres, and another individually to 95 local and foreign doctors last December.

“The issue of medical licenses that we consider fraudulent is moving in a very dynamic and liquid way, and as we attack the groups that generate the largest emissions, these also vary,” explains Francisco González, legal manager of isapre Consalud.

Along with expressing the expectation of the isapre in terms of “achieving positive results, since there are concrete antecedents for the Prosecutor’s Office to formalize and then the courts to sanction”, the executive pointed out that Consalud continues to assign priority to the detection of fraudulent licenses, for which “it is not ruled out to continue presenting complaints in the future.”

“There is the possibility of continuing to increase the universe. We continue to investigate internally, Consalud has a specific fraud detection area, and we are monitoring to see if new professionals appear who fall within our estimation that they are committing some type of illicit, and then assess the formalization of some action against them ” , indicates Francisco Gonzalez.

Spending for $7 billion

To date, Consalud estimates that irregular licenses have involved an expense of almost $7 billion in one year. Of the total number of licenses granted by the defendant doctors, the isapre indicated that 86% correspond to mental health causes diagnosed by doctors who do not have a specialty in psychiatry, to which it adds that almost 90% of them do not have previous associated care. to obtain this instrument. He adds that only in the case of medical licenses that are caused by some psychiatric pathology, the increase has been such that – so far this year – a panorama similar to that of 2021 is already in sight, where in a single semester a million were issued. and a half more than in the same calendar period.

Along with pointing out that as a health insurance institution “we do not criticize the existence of licenses as a health instrument, a public policy”, he emphasized that the questioning refers to an action “without control and sustained by doctors that causes social and economic damage. , because the misuse of licenses causes inefficiency to the system”.

Issues made from abroad

With eight million issues in 2021, representing an increase of 62%, the general escalation of medical licenses far exceeded the authority’s forecasts, especially due to the rise in mental health causes that amounted to 2.39 million operations nationwide. . Within this framework, the Superintendency of Social Security (SUSESO) committed last year to greater control of the use of this benefit, intensifying its observation of situations of high emissions of this instrument without the due foundation of health treatment and the identification of doctors whose practices are under observation in aspects such as, for example, their nationality and whether or not they reside in the country.

In relation to cases of licenses issued from outside Chile, the legal manager of Consalud points out that “we have detected cases, we have received complaints, and we are in the process of investigating and are preparing any corresponding complaints or legal actions.”

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