Controles activos y trabajo conjunto con la Justicia permitieron desarticular una maniobra de fraude que afectaba los recursos del sistema de salud.
APROSS inició una investigación interna que el día de ayer derivó en una causa judicial con trece personas detenidas.
Hace meses que el Seguro de Salud viene profundizando el trabajo para perseguir y eliminar el fraude en perjuicio de sus afiliados.
En esta oportunidad, cuando un afiliado advirtió, a través de su portal de autogestión, que aparecían consultas médicas que nunca había solicitado ni realizado e informó la situación a APROSS, se inició una investigación interna y se solicitó la intervención de la Justicia, acompañando la denuncia como querellante.
Todo este proceso es posible de ejecutar gracias a las inversiones en seguridad, desarrollos tecnológicos y mecanismos de control que hoy tiene el APROSS.
La Comisión Especial Permanente -integrada por la Oficina de Fraude de APROSS y el Ministerio Público Fiscal-, en colaboración con la Policía de la Provincia de Córdoba y la Dirección de Investigaciones Operativas, avanzó en la causa y logró detener a 13 personas.
Según la investigación, se validaban consultas médicas falsas, que luego eran facturadas y cobradas a APROSS.
Las prácticas nunca se realizaron, y se detectaron acciones intencionales para vulnerar el sistema de validación y generar pagos indebidos.Navegación de entradas
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