Several insurers that administer the Government Health Plan came forward on Friday to complaints issued by the Executive about its alleged withholding of payments related to the Quality Initiatives Program
The insurers involvedFirst Medical, Triple-S Salud, MMM Multi Health and the Mennonite Health Plan– They must comply with the Health Care Program Retention Fund, which means issuing payments to doctors and health providers who offer services to the 1,277,348 beneficiaries of the Reform.
In circular letter 20-0330, the Health Insurance Administration (ASES) asked the managed care management organizations for alternatives so that the primary medical groups (GMP) that were attending the emergency of the COVID-19 pandemic could keep operating.
“This unprecedented situation requires additional resources to be operationally viable; therefore, ASES has requested all MCOs (health organizations) various alternatives that allow GMPs to specify and maintain this strategy,” says the letter dated March 30, 2020.
Alternatives included the expeditious liquidation of funds held by the quality incentive or other reserves that would help the MSGs improve their cash flow. The four insurers involved had until this Friday to submit evidence of this compliance.
“At MMM Multi Health, we confirm that we have received a request for information from ASES. With the seriousness that characterizes us, we will be answering the same within the granted period. Hereby, we can affirm that we have made the payments as stipulated in the contractual agreements,” said Irmarie Cervera, director of communications for MMM Multi Health, on Friday.
Juan Serrano, president of Triple-S Salud, reported that they sent a letter to ASES assuring that they were “in compliance” with regard to the Health Care Improvement Program (HCIP) funds, that they “at no time” withheld that money and that do not have any related pending disbursement.
Mayra Rivera, Director of Communications for First Medical, notified in writing that this company was “in compliance with the applicable regulations and the corresponding contractual agreements”, and that they would respond “in a timely manner” to requests from regulatory agencies regarding the Quality Incentive Payment to the corresponding providers.
Meanwhile, Myriam Aguilú, communications spokesperson for the Mennonite Health Plan, said that they would meet the government’s deadline this Friday to answer their response to these payments.