IOMA medical providers, with the assent of auditors of the largest social work of the province of Buenos Aires, They collect revenue from supply companies and collect their prostheses. In the case of a refusal to pay bribes, health workers are threatened to reject all of the company's prostheses and choose another one to take an illegal payment, IOMA auditors do not address the reasons for these "refusals" or challenge them. Employees' social work in Buenos Aires should, at the suggestion of a physician, obtain another provider until he / she is satisfied with the agreed coim.
However, the payment of these proceeds for the purpose of securing business is not absorbed by the supplier, finally, IOMA pays the official Nomenclature overruns above 500% of market values, or because of that direct purchases that would have been pre-agreed.
The system is institutionalized, according to could recover Infobae the testimony of providers and trade unionists, phonograms and court documents agreed upon in the context of a global investigation Implant files on the medical devices industry led by the International Association of Investigative Journalists (ICIJ),
All who have been consulted by the ICIJ Argentine team, which also includes Infobae, The nation and Profile– emphasize it bribes to doctors go around 20% of what Buenos Aires's social work spends in a prosthesis, that is, for 2018, about 500 million pesos,
They also agree current social workers could not ignore the maneuver, And a few showed your responsibility and your participation in this system of surcharges and returns, at the expense of the greater social work of the province and its two million members.
On behalf of IOMA, the authorities assure that in 2016 the prices were reduced and there was a 20% reduction.
Revenue for "technical assistance"
Argentine team ICIJ has agreed with audiences revealed by this operator and have already been verifiable. In this phone conversation, a physician who must run a patient's hip by IOMA specifies the contractor's company the amount of bribe he expects to collect:
"Honoraria" – a "primary" question for a traumatologist who speaks of a common practice with his colleagues working for IOMA – is the euphemism he refers to for the revenue he receives.
In this case, an 18,000 pesos bribe is required for an anchor. "Do not kill them and make them logical. And maybe so we can start working", justifies the health professional.
Infobae does not disclose the name of the attending physician because it is being dealt with by justice and, at his request, distorted the voice of the IOMA provider for fear of retribution. He also decided to retain the identity of the patient.
In this second sound, another orthopedic surgeon agrees with an orthopedic employee to pay for the placement of his signature for the reconstruction of the femur of a patient who has to work.
The "25" data, which "drives" the physician, corresponds to 25,000 pesos, the estimated cost of using this prosthesis provided by the provider, in the surgeon's surgery for the social work of Buenos Aires.
Proposals for doctors go around, on average, 20% of the price of the prosthesis required, according to various respondents for this survey. They are usually masked as alleged "technical assistance" or "advisory fees", and pay with checks. The doctors then issue a confirmation to the grantor of the amount of bribe they receive. "Physicians regard this as a right and have naturalized it"acknowledges the supplier, resigned.
"If anyone was looking at me, I would see that every doctor's request for a prosthesis in a house is a" technical assistance "confirmation," he adds. These statements or invoices from doctors for non-existent services allow companies to deduct these payments from income tax if they are held as "expenses" in the accounts.
Although IOMA health providers are not linked to a single union, the Argentine team Implant files consult with various healthcare associations. In the medical federation of the province of Buenos Aires (FEMEBA) they refused to make a statement because they do not know the details of a judicial investigation. In the union of health professionals in the province of Buenos Aires (Cicop), President Marta Márquez argued that the position of the department "strongly contradicts this kind of practice" when it refers to the yields required by doctors to the suppliers of prostheses.
Much more forceful was the union secretary of the Association of Private Physicians Antonio Di Nanno: "For me, the doctor who does it the prisoner must go, just like any other criminal. But It would also be good if those who sold them and those who allowed themAnd there it is. You have to report them. "
For Graciela Ocaña, who, as former Minister of Health, has condemned the bribery in PAMI on several occasions,this is an installed practice in which victims are ",
Deputy Cambiemos explains that "doctors who are treating patients with IOMA who need any of these prostheses will start the negotiation process, communicate with supply companies, ask for a refund, and choose a company's prosthesis that pays more." Upon reaching an "agreement" with the provider, the doctor prescribes the denture of the company.
This is proved in this order by a traumatologist – whose name has been deleted so as not to interfere with the investigation – which prescribes for the patient a IOMA prosthesis from a particular orthopedic home.
Deputy Cambiemos denounced the maneuver last August on the basis of the information he had received about renting a prosthesis in the social work of employees in Buenos Aires, so possible offenses of fraud, misuse of authority and breach of duties of a public official and bribery, at the expense of IOMA, "We are talking about the health of thousands of people from Buenos Aires. IOMA can not afford a parallel channel that would be paid by doctors", he says.
He did it before the Office for Institution Building (OFI) of the province of Buenos Aires, which has already received a previous complaint in this matter. Corruption control body in Buenosaire received Ocaña's presentation to the silver judge in last October, and the investigation is now entrusted to Marcelo Romero, which identified at least five doctors involved in this practice, and has already ordered a number of testing measures, Between them, IOMA sent an office requesting to state the denture acquired during the last five years, the doctor who requested them, the rejected reasons, the auditor's reasons and decision, and the list of providers.
More than a month later, social work –whose president Pablo Di Liscia appointed provincial executive- she still did not respond, Di Liscia, who had previously worked in Buenos Aires since Maurice Macri's arrival as prime minister in 2007, entered office in December last December after the government of María Eugenia Vidal refused a former official Carlos D'Abate.
EIOMA President, Pablo Di Liscia, and Nicolas Galoppe, Manager of Intergemed, a company that has been condemned by SUPTTIOMA.
Ocaña's complaint about these maneuvers is not the first to reach justice. In November 2017, the person with an identity reservation contacted the OFI with information and documentation on about 20 similar cases of physicians who participated in them maneuvers.
A preliminary examination of the OFI includes the statement of at least six patients affected by this maneuver, which the doctors postponed or discontinued the surgery, or in one case the patient had to pay for the prosthesis from the pocket. In all cases doctors refused prosthetics provided by IOMA.
The OFI referred to the denunciation of justice in June of last year,He played at UFI No. 2 Betina De Lacka. But he still had no moves.
85% of purchases of prostheses made by Buenos Aires are governed the nomenclature of the framework agreement fixing the reference prices, and that was itattached in 2016 between the IOMA Directory and the Provider, essentially manufacturers and distributors of medical prostheses and orthopedics. In August it was adjusted by 25%. But you that prices are superior to market prices, according to all consulted.
"In practice, they act as unique prizes, because nobody trades below, I pay less and do not buy a prosthesis. This price is for revenue. The higher the price, the greater the bribe"explains the provider, provided he does not know his name.
Ocaña emphasizes that "companies that have to pay bribes need the price of the prosthesis nomenclature to be higher than the market value, without this obligation the company can not cover the extra costs of bribes"
As an example, he states in his complaint that the cheapest value of the primary cement bed in the Mercosur IOMA nomenclature, agreed in 2016, is $ 34,600. However, in orthopedics the value was 5,500 USD plus VAT. Meanwhile, DHS and DCS rider for the same nomenclator will pay $ 23,232 for IOMA, but at market prices of $ 3,500 plus VAT. This means that, according to the price data submitted by the representative, IOMA is valid in 2016, 2017 and by August 2018 more than 500% for prostheses.
The budget submitted by the orthopedic femoral prosthesis required by a traumatologist for this house whose price exceeds the market value.
Idelmar Seillant, President of the Association of IOMA Experts (APIOMA), confirms that the agreement, which was signed in 2016, had "values up to 700% higher than the market with the intention of giving preference to millions of entrepreneurs," which is "associated with officials".
After stating that "it is a systemic circuit that covers the vast majority of prostheses", it points out that APIOMA and the Uniform Trade Union of IOMA (SUPTTIOMA) experts and technicians also carried out a survey that will brought before the justice to which he had access Infobae. It states in detail, for example, that frames with codes OSI 11 and OSME 11, which under the IOMA agreement pay USD 30,500 and USD 24,400, have a market value of between 3,000 and 5,000 USD plus VAT,
Price release APIOMA and its SUPTTIOMA association.
For Ocaña "this maneuver of yields could not be done without the consent of doctors, but nor without the participation of the IOMA authorities responsible for fixing the prices laid down in the nomenclature, which are always well above market prices. Without this condition, fraud would not be viable"
The deputy also compares the prices set in the social work of Buenos Aires with the prices paid by the Provincial Ministry of Health for providing prosthetics to public hospitals in the province. "In the case of offers and individual purchases, the price difference is between 20% and 30% lower than the prices specified in the IOMA Nomenclature."
Graciela Ocaña condemned these practices as soon as the information arrived.
Before consulting the ICIJ Argentine team, IOMA has refused to respond to the existence of bribes when providing a prosthesis or to recognize that the values paid by IOMA are much higher than the values paid by the market,
Instead, they decided to explain that the prices of prosthetic traumatology – 35% out of 500, which make up the nomenclature – were "dollarised (led by Daniel Sciol) and they were pesified in 2016, with a 20% reduction"They added it to
in August last August "in response to the lack of provision of providers in relation to the composition of these products in dollars and in order to avoid the interruption of the planned operations, social work defined to apply an increase of 25% of these values, However, the entry from Mercosur has been exempted from this update, which, depending on current prices, even if it was pens, did not receive this increase. "
IOMA is damaged not only by these overrated remorse but also because the negotiations between a doctor and a provider paying a higher yield slow down surgery and social work has to take care of other days of hospitalization. "This operation is which is a criminal system that costs IOMA hundreds of thousands pesos, increase the length of hospital stay, saturate the allowance allowances needed for other patients, and tighten hospital hospitalization, which has often cost lives, "adds Ocaña.
Only a small percentage of prosthesis purchases – between 5% and 10% This is done through a selection procedure, directly from hospitalsBut, according to the respondents, the scheme is repeated: the winning company must be guaranteed by a doctor who asks for a return. If the provider fails to pay a bribe, the doctor will drop the denture.
"The doctor can choose the material he wants even if he is more expensive, allegedly" technically. "It's an incredible thing. The company that offers the best price does not play. If a physician wants more expensive material, the one who won the prize may not even go through, Directly selecting his signature fist and a letter of the company's denture to repair "complains to another supplier in the dialogue Infobae,
One of the contractors interviewed stressed that "the most serious thing after a doctor rejects a prosthesis because the company does not pay a return is IOMA auditors will approve this rejection without questioning the reasons"
In this note, to authorize the placement of a hip prosthesis from June 2017 and addressed to IOMA Supplies, the physician who signs it – whose identity is reserved for ongoing judicial investigations – rejects what the company offers and requests the name of another supplier on behalf of orthopedics (not even a brand) argue "Trust and knowledge of tools"
"No one doubts you for refusing it, and the auditor then authorizes the prosthesis required by a doctor of another provider with a similar advantage and probably more expensive. They are accomplices"adds to a creditor who, like all the consulted – without exception – has asked for an identity reserve because they claim to have been threatened by people associated with UPCN.
Ocaña warns that the current nomenclature system "gives physicians enormous power to decide which prosthesis should be charged by IOMA," but also points to the responsibility of social workers. "Auditors are actively involved in these frauds who are responsible for the duty to control operations so that they do not happen, for gross violation of the duties assigned to them"
In fact, three of them were removed from IOMA were reported to have "been given orthopedic checks"Reminds Seillant, who also agrees that auditors usually disagree with rejecting some of the doctors' doctors.
The ICIJ Argentine team consulted with IOMA if the social work auditors filed complaints about the doctors but received no response.
Officials and trade unionists
This year, IOMA's budget is 44,000 million pesos, of which 5,6% is spent on the purchase of prosthetics. In this area, they reach almost 2 500 million pesos a year, which is an amount that would include the payment of revenue. This is an amount that amounted to 500 million a year for illegal payments.
According to Seillant,the premiums include not only 20% of the value of the prosthesis for doctors, but another 20% of the amount charged by the IOMA provider and go to the officials, Return system and surcharges it could not function without the participation of the Board of Directors, which allows the payment, overpayment and management of certain providers ",
Owner of the orthopedic prosthetic distributor also points to the political leadership of IOMA"If you do not change it, you will not change anything because you are aware, otherwise the system will not work."
Another vendor of orthopedics says – not without harassment – that "this has always been the case, if there is no order from above, it will not change, those who have to change it must be willing to do it."
Another provider of prosthetics ensures that "selling IOMA, you can take your folder and imagine, but without political or trade approval, will never call you. Many companies are associated with a guild that protects them"Guild is UPCN, headed by Carlos Quintana, who returns to IOMA and cope well with the government of Eugenia Vidal.
Direct purchases "masked"
Many times prostheses that are required by doctors or offers that are issued to provide a hospital or clinic that cooperates with IOMA have a very specific technical description. "It draws them as though they were very complex. But that's all that justifies us pulling them out of the nomenclature and buying them for an exaggerated price"says a small entrepreneur from the sector that was consulted for this investigation.
Seillant – whose APIOMA group assembles approximately 70 auditors from IOMA – agrees and adds that "these purchases are directed to selected suppliers who are connected with UPCN officials and leaders in social work. These are masked direct purchases"
IOMA has in the meantime clarified that if a prosthesis is not a nomenclature, "given that IOMA's priority is to meet the need for time and the form of its members, we will proceed with pricing control to ensure delivery to the affiliate, which is a fundamental pre-approval honorable list according to the exception procedure. "
They stressed that this certificate is published on the IOMA website "in order to achieve the highest price competition and other suppliers are also invited to quote the required product or entry." The medical audit area with regard to the technical specifications that the entry must meet, which is less he did not report to the prosthetic entry provider, contacted directly by the effector and the attending physician and continued his immediate dosing. "
However, this explanation does not meet the testimony issued by the ICIJ Argentine team.
According to the latest analysis by APIOMA on IOMA Expenditure on the basis of the Provincial Court's number, between January 2016 and October 2018, there were 4,800 million pesos that were converted into surcharges to companies linked to UPCN officials and unionists.
Among the IOMA providers that SUPTTIOMA mentioned about their links with various UPCN leaders, it mentions Hestía SRL, Continium and Alpatec SRL.
Representative of the UPCN Committee is Patricia Wilde, who replaced the previous singing of Luis Ángel Pérez, who was imputed by Alvaro Gargan, Prosecutor of the IOMA mega-cause. Another union member of the headquarters was Patricia Nisembaum of Suteba, a teaching association led by Robert Barlad, and was also displaced because she was accused of a case filed by Elise Carrió's complaint.
Seillant condemns the "human resources area protects the Board of Directors in question" and claims that the current administration "not only does not cooperate with justice but is prosecuted by APIOM's auditors for condemning corruption."
Idelmar Seillant, President of APIOMA and his SUPTTIOMA division.
Since 2011, SUPTOMA has conducted legal proceedings for 27 complaints about bribing irregularities and resource management at IOMA, of which about ten of Cambiemos' arrivals have been made. "There is absolute continuity." New authorities have ratified Scioli's decision there will be no more land, management and accounting audits. Then there are no controlsWhat has been agreed with providers is valid. It's the same dog with another collar"Seillant says.
Consulted providers without exception have asked for an identity reservation to "continue their work" or for fear of endangering their physical security. Those who dared to condemn were tightened and / or threatened.
According to their testimony, those companies that do not accept entry to the illegal payment scheme consider it very difficult to sell their products to IOMA, "If the proceeds are not paid, doctors keep the documentation or do not sign the documents that IOMA requires for billing," one says.
"If you do not specify a tongo, you can not work. I want to, let me sell. I'm not interested in having two doctors in prison, I'm interested in changing the system"admits another who has decided to start looking for work in another area.
As far as responsibility of IOMA officials, argues that "there is no answer to the claims of suppliers who do not want to pay bribes, because the defendants are doctors who work with companies with whom they have "agreements". "
In this sense, Ocaña also warns that "despite receiving complaints from providers, IOMA has never taken the necessary steps to put an end to this perverse system that leaves companies wishing to work without paying income"
It would also be possible to work with the IOMA prosthesis previous agreement between tenderers, "There is an established system, so if the company has already arranged with a doctor, do not put others into business," explains one of the consultants in the consulting sector. Even there will be the WhatsApp group, in which they highlight the hospital and sanatorium offerings that IOMA participates in and quote the medicine that is being offered for others to not.
"This happens at IOMA, it will be in PAMI and other social works. Finally, later, If the prosthesis is very expensive, the APE payment (management of special programs that depends on the Ministry of Health) ends. That is all"concludes one of the providers who, for refusing to pay bribes, were forced to look for another alternative to survive.
The Argentine team of the International Research Journalism Consortium that participated Implant files is integrated by Mariel Fitz Patrick (Infobae); Maia Jastreblansky, Iván Ruiz and Ricardo Brom (La Nación); Emilia Delfino (profile) and Sandra Crucianelli (profile).