Audited by ADRES for traffic accidents
Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva
This blog shows the figures on the audit carried out by the aforementioned administrator to the invoices for traffic accidents only, from the years 2016 to 2020, differentiated according to the type: ghost car, without SOAT (includes fake SOAT) and insured.
In the previous blog , the analysis of the ADRES budgets for traffic accidents, catastrophic events and terrorist acts was carried out, including the collection from the SOAT and the execution of the three concepts.
This blog shows the figures on the audit carried out by the aforementioned administrator to the invoices for traffic accidents only, from the years 2016 to 2020, differentiated according to the type: ghost car, without SOAT (includes fake SOAT) and insured. Likewise, the disaggregation of the values presented, approved and glossed is carried out, to end with the percentages approved by each one.
As explained in the last blog, the data was obtained from the ADRES through the right of petition , since they were not sent within the term established in the legal norms that regulate the matter, for which a guardianship action was necessary. and the presentation of an incident of contempt , finally obtaining the answer .
In the aforementioned period, the invoices that ADRES received for traffic accidents and the values presented, approved and glossed, are presented below:
As shown in Table 1., 1,319,276 invoices were received in the five years reviewed, with 2018 being the year with the highest number of invoices presented, representing a total of 326,795, and the year with the lowest number, in 2016 with 222,376 invoices. . These invoices constitute claims for a little more than $2 billion, of which 44,43% ($888.831.267.120) was approved. Of the five years evaluated, 2017 was the one that presented the highest approval value with 52,96%, and 2016 the one that documented the lowest approval value with 39,21%. The foregoing shows that the glossed value is higher than the approved value.
Regarding the above information, it is important to bear in mind that the ADRES began its operation in 2017, therefore, 2016 corresponds to the process carried out by the FOSYGA.
Invoices according to type
As explained before and for the purposes of charging for health services provided, traffic accidents are classified as follows: those involving ghost vehicles, that is, those that were not identified; vehicles without SOAT or with this fake; and those of vehicles whose claim exceeded the values determined in the SOAT and according to legal regulations, the ADRES can be charged up to a limit that varies each year according to the increase in the monthly minimum wage.
Table 2 shows the number of invoices presented by each type, as well as the values presented, approved and glossed, and the percentage approved by each one.
In the above figures it is evident that ghost vehicles are the ones that present the greatest amount of attention and invoices, and in turn, those with the highest charged, approved and glossed values. The significant value of the invoices corresponding to vehicles without SOAT stands out. However, the value presented and approved by the insured vehicles is minimal compared to the other two types of traffic accidents. Regarding this, it should be specified that it corresponds to vehicles that had their SOAT in force and in the care of the injured persons the values established for the insurance were exhausted, so it was necessary to resort to the additional amount paid by the ADRES.
In the previous blog , it was shown that there are sufficient financial resources to pay the bills submitted for traffic accidents, catastrophic events and terrorist acts. In fact, between the years 2018 to 2020, in which the ADRES fully operated, there is a surplus of $663,135,392,712, as a result of the difference between what was collected and what was executed.
In this vein, it is clear that the payment restrictions are generated in the audit process, since the glossed percentage is higher than the approved one. A similar scenario had been evidenced by the endpoint agreement audit.  Such a situation could have the following causes: the inadequate presentation of the invoices by the clinics and hospitals or the excessive rigorousness of the audit carried out by the ADRES, and eventually, a mixture of both.
In the midst of health providers there is a permanent complaint about the delay in ADRES payments, according to some managers of clinics and hospitals, mainly public, the delay is greater in those that were presented before 2017, that is, when FOSYGA was in operation.
On the other hand, the values presented by vehicles without SOAT or with this false document are surprising and worrying, which implies that the collection would be even higher if a stricter management were made in the compliance of the vehicle owners in relation to the insurance .
However, it is important to question the need for a higher collection, knowing that money does not flow swiftly, which would imply greater surpluses, without representing a real benefit for those who care for injured patients.
In any case, it is still contradictory that there are money to cancel the services provided by the IPS, but these entities permanently manifest liquidity problems and that payments are limited by the audit, either due to inadequate presentation of invoices, slowness in the process or because part of these are glossed for no reason.
Finally, it is essential to take into account that the invoices and the audit process continue to be similar to what was done in 1993, the year of approval of Law 100, without the regular use of new information technologies and tools to date. big data, which would speed up the process and the corresponding payment.
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2. File CAS-256580-S6Y7B8 of May 27, 2021.
3. Guardianship judgment dated August 3, 2021, filed process No. 11001 31 09 029 2021 000186 00, issued by the 25th criminal circuit court with a hearing function in Bogotá.
4. The information was finally received by official letter 20211600423701 dated August 18, 2021, signed by Mauricio Ramírez Espitia, director of other benefits of ADRES
6. See blog: https://www.neuroeconomix.com/es/cuanto-se-audito-en-el-acuerdo-de-punto-final