IOMA's healthcare providers, with approved pre-approvals from auditors of the largest social work of the province of Buenos Aires, They collect returns from suppliers to select their prosthesis. In case of refusal of bribery, Health workers threaten to reject all prostheses of this company and choose someone else who accepts illegal payments.. IOMA auditors do not ask and challenge the reasons for these lar rejections I. The social work of employees in Buenos Aires should take another provider with the doctor's recommendation until they are satisfied with the agreed coexistence.
However, payment of these returns to guarantee the work is not absorbed by the supplier. Exceeds 500% of market values and ends with IOMA over the overprices established by nomenclatoror direct purchases to be agreed in advance.
The system was institutionalizedby rebuild Infoba to from suppliers and trade unionists, voices, and court documents Implant Files In the medical devices industry, managed by the International Investigative Journalists Consortium (ICIJ),
Including those consulted by the Argentine team of ICIJ Infoba to, Nation and profile– sign this The bribery given to doctors is about 20% of what the social work of Buenos Aires spends in prostheses., this is implying for 2018 about 500 million pesos.
They also accept Existing staff of social work cannot ignore the maneuver. And a few your responsibilities and responsibilities in this scheme and responsibilitiesAgainst the larger social work of the province and two million members.
Officials from IOMA say prices have fallen in 2016 and a decline of 20%.
"Technical assistance" receipts
ICIJ Argentina team He decided on the voices that revealed this activity and were already tried. In this phone call, the doctor who has to operate the patient's buttocks by the IOMA shall determine the amount of the amount to pay the bribe to the supplier:
"Honoraria" – a "primordial" problem for the traumatologist who speaks about an application shared with colleagues working for IOMA is the euphemism referred to their feedback.
In this case, for a hip prosthesis, the desired bribe is 18,000 pesos. "Don't kill them and it makes sense for them. And maybe we can start working like this."justifies the health worker.
Infoba to He did not disclose the name of the doctor concerned because he had been investigated by justice, and he distorted the voice of the IOMA provider because of the fear of retaliation. He also chose to protect the patient's identity.
At this second volume, another orthopedic surgeon agrees to pay for the orthopedic worker to place a prosthesis bearing the signature for reconstruction of the patient's femur that needs to be operated.
The "25" figure of the physician is equivalent to an estimated cost of 25,000 pesos for the use of the prosthesis provided by the provider in a surgery where the doctor undertakes his social work in Buenos Aires.
The doctors are going back, on average 20% of prosthesis costAccording to different interviewers for this investigation. They are usually camouflaged as "technical support" or "consulting fees", and check with check. Doctors, in turn, issue receipts to the provider for the amount of bribes they receive. "Doctors think of it as an acquired right and naturalize it."recognized a supplier, resigned.
”If someone were to look, I would see that there was a receipt for istek technical assistance“ for every request from a prosthesis physician in a particular home, “he adds. These receipts or invoices from physicians for non-existing services can be deducted from the Income Tax when companies are recorded as "charges ild in their accounts.
Although IOMA's medical providers are not affiliated to a single union, Argentinean Implant Files He applied to different associations of health workers. He refused to take statements because he did not know the details of the criminal investigation in the Medical Federation of Buenos Aires Province (FEMEBA). In the Union of Health Professionals Union of Buenos Aires (Cicop), President Marta Márquez argued that the positions of the trade unions were "strongly opposed to such practices", referring to the doctors' demands for suppliers. prostheses
More empathetic, special event union secretary of the Physicians Association, Antonio Di Nanno: "A doctor who did this for me she has to go to prisonerLike any other criminal. but Those who sold them and the authorized ones would be good too. And there is the state. You have to report them. "
As former Minister of Health, Graciela Ocaña told many opportunities in PAMI:This is a loaded application where the victims are sick ".
"Physicians who treat IOMA patients who need a prosthesis, who start a negotiation process, communicate with supplier companies, demand a return, and pay more are paying for the prosthesis of the company," Cambiemos said. After the "agreement" has been made with the provider, the doctor prescribes that company's prosthesis.
In this order, the traumatologist proved that a patient with an IOMA was wiped out of a specific orthopedic home with a prosthesis prescription to avoid interfering with the problem.
Last August, the Cambiemos deputy condemned the maneuver based on information on the recruitment of prosthesis in the social work of Buenos Aires employees. possible fraud offenses, abuse of authority and violations of the duties of a public official and briberyAgainst IOMA. "We're talking about the health of thousands of people from Buenos Aires. IOMA cannot allow a parallel channel to be paid to physicians"says.
He did Before the Corporate Empowerment Office (OFI) of Buenos Aires, who previously filed a complaint about this issue. The control organism of the Buenos Aires corruption has been submitted to Ocaña's Silver Justice last October. The investigation is today under the responsibility of prosecutor Marcelo RomeroAt least five doctors in this application already ordered a series of testing measures. Among these, IOMA has sent an office requesting the IOMA to list the prostheses it received in the last five years, the doctors who demanded, the denied, the reasons and decisions of the auditors and the list of providers.
Social work after a month –Appointment of President Pablo Di Liscia by the Provincial Director General still didn't answer. Di Liscia, previously a Buenos Aires executive who had been in charge of Mauricio Macri's government since 2007, had begun his duties last December, and then the government of María Eugenia Vidal had previously served as a current incumbent Carlos D & # 39; Abate & # 39; i took it off.
TOIOMA President Pablo Di Liscia, together with Nicolas Galoppo, manager of Intergemed, a firm condemned by the SUPTTIOMA technical association.
Ocaña's complaint about these maneuvers is not the first person to reach justice. In November 2017 A person with an ID applied to OFI with information and documents about about 20 similar physician cases involved in this work. maneuvers.
The preliminary investigation of the OFI included statements from at least six patients affected by this maneuver, the doctors would postpone or postpone their surgery, or in one case, had to pay the prosthesis from his pocket. . In any case, doctors rejected prostheses provided by IOMA.
OFI filed a complaint to Justice last June andHe played at UFI # 2, Betina De Lacky. But there was still no movement.
85% of the prosthesis purchases made by the social work of Buenos Aires a candidate for a framework agreement that corrects reference prices, and this is goneIOMA Directory in 2016 and cordoned between providersManufacturers and distributors of medical prostheses and orthopedics. It was set at 25% last August. But these are prices are higher than market pricesconsulted
"In practice, they work as unparalleled prices, because no one trades below, pays less and doesn't buy dentures. This covers the price return. Higher price, greater bribe"discloses a provider provided that it does not disclose its name.
Ocaña, "Companies that have to pay a bribe need to have a higher price than the market value of the prosthesis's price, without which companies cannot afford to pay the extra cost of bribes.".
As an example, he claims that the cheapest value of the IOMA primary cement mold in Mercosur nomenclator in 2016 is $ 34,600. However, the value in orthopedics was US $ 5,500 plus VAT. Meanwhile, by the same nomenclador as the nailboard slider DHS and DCS, IOMA pays $ 23,230, but the market is $ 3,500 plus VAT. That is, according to the price figures presented by the deputy, IOMA 2016 was paying more than 500% for prostheses until 2017 and August 2018.
The price offered to the femoral prosthesis requested by an orthopedist by the traumatologist exceeds the market value.
Idelmar Seillant, chairman of the IOMA Professionals Association (APIOMA), confirmed this. The agreement signed in 2016 included olarak values up to 700% from the market with the intention of supporting entrepreneurs with millionaires in relation to authorities 39.
After stating that Tek a systematic circuit covering the vast majority of prostheses “, IOMA (SUPTTIOMA) has prepared a questionnaire from the Union of Workers and Technicians Technicians (APIOMA and Unity). Before justice, he had access. Infoba to. For example, IOMA & # 39; s agreement with IOMA & # 39; s agreement with the code of $ 30,500 and $ 24,400, the code is coded with OSi 11 and OSME 11 codes, 3.000 to 5.000 dollars between a market value, explains. .
Price relaxation made by APIOMA and its SUPTTIOMA union.
Ocaña for "This repayment maneuver could not have been done without the donation of doctors, but without the participation of IOMA officials who are responsible for determining the prices in the candidateMarket prices are always very high. Without this requirement, fraud does not apply".
The deputy also compares the fixed prices of social work in Buenos Aires with those paid by the Provincial Health Department to provide prosthesis to public hospitals in the province. "In offers and individual purchases, the price difference is between 20 and 30% of the prices set in IOMA nomenclator."
Graciela Ocaña, condemned these practices when it reaches information.
Before consulting the Argentine ICIJ team, They refused to respond to the existence of bribes from the IOMA in the provision of the prosthesis, or did not accept that the values paid by the IOMA were higher than those in the market..
Instead, the prices of prosthetic traumatology – which accounted for 500 percent of the 500 – $ 35 million – were directed at Daniel Scioli. Was hesitated with a discount of 20% in 2016"They added this
last August, "to ensure that the cost of these products in suppliers' procurement by suppliers is not supplied in dollars and the planned operations are not interrupted, Social work defined to apply an increase of 25% on these values. However, entries from Mercosur were excluded from this update. These updates did not take this increase, even if they were hesitant, depending on the current prices Bu.
IOMA has suffered not only because of these overly expensive reports, but also because of the functioning of the negotiation between the physician and the provider paying a higher return and the need for longer hospitalization. "This operation IOMA is a penal system costing hundreds of thousands of pesosOn the other hand, it increases the length of hospitalization, satisfies the bed quotas required for other patients, and manages hospitalized patients, usually hospital risks that cost their lives.
Only a smaller percentage of prosthetic purchases – between 5% and 10% – It is done directly by the tender from hospitals.. However, according to the interviewers, the program repeats itself: the winning company must be guaranteed by the doctor who wants to return. If the provider does not pay the bribe, the doctor will reduce this prosthesis.
"The doctor may technically choose the material he wants, even if it is technically more expensive." It's incredible. The company offering the best price cannot win. If the doctor wants a more expensive material, the price will not even have to go through the winner.. With the direct signature fist he should select the company's prosthesis, Infoba to.
One of the suppliers interviewed said, ez The most serious thing that a doctor rejects his prosthesis is, because the company has not paid back, IOMA auditors confirm this refusal without asking their justification.".
In this note, in order to approve the authority to place a hip prosthesis in June 2017 directed to the IOMA Instruments, the physician who has been assigned to the judicial investigation signing his identity rejects the offer submitted by a company. discuss the name of another supplier by orthopedics (not even by brand).Trust and knowledge of instruments".
"No one wants you to verify this denial, and Then, the supervisors allow the dentist requested by another physician to have a similar benefit and possibly more expensive. They're accomplice# Such as those consulted with the exception of the exceptional case, the lender requesting for identification identifies the lender because he claims that he is being threatened by people connected to the UPCN.
Ocaña says that the current nomenclator system "gives the doctors tremendous power to decide which prosthesis should charge the IOMA", but also points to the responsibility of social workers. "Auditors have active participation in these frauds. Those responsible for the task of controlling the operations shall be in a position where there is a".
Actually, three of them after IOMA left "Orthopedic checks""Seillant also accepts that supervisors generally do not oppose doctors for refusing some prostheses.
ICIJ's Argentine team appealed to IOMA, but did not receive a response, when there were complaints from physicians by the auditors of social work.
Officials and trade unionists
This year, IOMA's budget is 44,000 million pesos, 5.6% to buy prostheses. Some 2,500 million pesos annually in this area, including reimbursement of returns. It is an amount of 500 million per year in illegal payments.
According to Seillant,The premiums not only leave 20% of the prosthesis value of the doctor, but also the 20% of the amount received by the IOMA provider.. System of returns and surcharges The payment did not work without the participation of the Board of Directors, which provided excessive pricing and guidance to specific providers eyi.
Orthopedic prosthesis holder also points to IOMA's political leadership"If you don't, nothing will change because you are aware, otherwise the system will not work."
Another dealer of an orthopedist, without discomfort – "always has been like this, if there is no order from above, it will not change, those who have to change it, must be willing to do so".
Another prosthesis provider, "IOMA & # 39; selling, you can receive your folder and introduce yourself, but without political or trade union turnovers will never call you. Many companies are linked to the guild that protects them."The guild is the UPCN, led by Carlos Quintana, who stands in the IOMA and is compatible with the government of María Eugenia Vidal.
Direct purchases "masked"
Often, there is a very specific technical explanation in the proposals published by the physicians to provide a hospital or clinic that works with prosthesis or IOMA. "They draw as if they were extremely complicated. However, it is only in a verse to justify the removal of all of these from the candidate"He consulted a small businessman from the sector for this investigation.
The group APIOMA brings together 70 supervisors from the IOMA.These acquisitions are directed to selected suppliers linked to UPCN officials and leaders of social work. Direct purchases masked".
Meanwhile, from the IOMA, when a prosthesis turns out to be not a ında nomenclad ac, ac IOMA & # 39; s priority meets the needs of members in time and form, so we continue to carry out a price check to ensure delivery takes place. For the subsidiary, in this case it is necessary to prior approval of the Honorable Directory with the exception procedure ".
In order to achieve the highest price competition, this certificate was published on the IOMA website and additional suppliers were invited to offer the necessary products or inputs. The area of medical supervision is less than the technical specifications required by the input. If the prosthesis input provider is not notified, this situation will be continued to be delivered immediately with the physician and the requesting physician ".
However, this statement does not match the testimony of the Argentine ICIJ team.
According to the most recent analysis by IOMA, APIOMA, based on the numbers of the TCA, Between January 2016 and October 2018 there were 4,800 million pesos paid to companies to be contacted with UPCN officials and trade unionists for an additional fee.
Among the IOMA providers reported by SUPTTIOMA for connections with different leaders of the UPCN said: Hestía SRL, Continium and Alpatec SRL.
The representative of the Executive Board of the UPCN is Patricia Wilde, who replaced Luis Ángel Pérez, the previous vocal performed by prosecutor Alvarao Garganta of the mega case of IOMA. The other union member of the directorate was displaced by Patricia Nisembaum, SUTEBA, who was led by Roberto Baradel, because he was employed in the case brought against Elisa Carrió.
Seillant argues that "The Human Resources field protects the query of the members of the Board of Directors" and that the current administration "not only cooperates with justice but also persuades the APIOMA auditors to condemn corruption".
Idiomar Seillant, head of the APIOMA and the union SUPTTIOMA.
Since 2011, SUPTTIOMA has made 27 complaints in the courts, using dozens of resources and managing resources in IOMA, a company from a dozen offices since the arrival of Cambiyasos. I There is an absolute continuity. Sci New officials approved the Scioli government's decision. land, management and accounting controls would no longer be. Then don't check.. The providers are paid with what is accepted. Same dog with different collar"Seillant says.
Unqualified service providers asked, without exception, that they were afraid to book an identity or to jeopardize their physical security in order to İst continue working İst. Those who dare to condemn were bored and / or threatened.
According to their statements, Companies that do not accept the transfer of illegal payments find it difficult to sell their products to IOMA.. Tanesi If the refunds are not paid, the doctors will protect the documents or they will not sign the IOMA's invoicing papers, “he says.
"If you do not enter Tongoya, you cannot work. I want him, they let me sell. I'm not interested in two doctors in jail, I'm thinking about changing the system."accepts someone else who decides to look for work in another area.
related to Responsibility of IOMA authoritiesargues, "there is no answer to the claims of suppliers who do not want to bribeBecause the defendants are doctors who work with companies that have şirket regulations Çünkü. "
In this sense, Ocaña,, despite complaints from providers, Bu IOMA has not taken the necessary measures to end this perverse system, which leaves companies willing to work without paying refunds".
Providing prosthesis to the IOMA A prior agreement between the bidders. "If a company has already been set up with a doctor, there is a system set up so that it cannot be put on another job," explains one of the industry's suppliers. In fact, there will also be a WhatsApp group that warns their offerings to provide a hospital and sanatorium that comes to offer the medical product that is offered to IOMA and will not bid on others.
"This happens in IOMA, PAMI and other social studies. And then, If the prosthesis is too expensive, the payment of the APE (Administration of Special Programs under the Ministry of Health) is terminated. That is allVet concludes one of the providers forced to seek another alternative to survive, because it refuses to bribe.
The Argentine team of the International Research Journalism Consortium Implant Files Mariel Fitz is integrated by Patrick (Infobae); Maia Jastreblansky, Iván Ruiz and Ricardo Brom (La Nación); Emilia Delfino (Profile) and Sandra Crucianelli (for Profile).