Insurance Companies And The Exodus Of Doctors From Puerto Rico

Futile the Government’s actions to stop the exodus of doctors from Puerto Rico if healthcare plans do not open their preferential net stated Rafael Rodríguez, Secretary of the HealthCare Department, according to the article “Maniatado el gobierno en esfuerzo por mantener a los médicos en la Isla” by Leysa Caro González, published in the newspaper El Nuevo Día on February 15, 2017. Rodríguez indicated that if opportunity to become providers of insurance companies were not given to young and recently graduated doctors, they will end up leaving Puerto Rico. While Victor Ramos, President of the College of Surgeon Doctors agrees with Rodríguez, he also indicated that currently doctors have to wait around a year or year and a half in order to know if the insurance companies are going to employed them or not.

Ramos indicated that insurance companies have created what is known as preferential nets, which makes some doctors disappear since, even when the patient decides to be treated by these doctors, the deductible that they will pay is higher than what they would end paying if they are treated by a doctor that is part of the preferential net. He also stated that another factor for doctors to choose to leave Puerto Rico is the recent practice of insurance companies of unilaterally canceling contracts with the doctors and retaining and denying payments.

Currently, through the Resolution of Chamber 56, an investigation has been ordered over the following healthcare plans: Medicare Advantage, Triple-S Advantage, MCS Advantage, Centros de Servicio Medicare y Medicaid, Aveta y sus subsidiarias, MMM, PMS Medicare Choice y MSO of Puerto Rico. Rodríguez stated that the majority of the beneficiaries of Medicare in Puerto Rico belong to the “advantage” plans. He also stated that it is the Legislature and the Insurance Commissioner who have to make insurance companies to comply with the laws. Rodríguez expressed that, to his understanding, the Office of the Insurance Commissioner has not implemented its functions as it should.

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According to the article “Fraude a Medicare trastoca imagen de la Isla” by Melissa Correa Velazquez, published on the newspaper El Vocero on February 26, 2017, Puerto Rico’s image has been affected by cases of fraud to Medicare, especially now when equity in the designation of funds to the Medicare program have been requested to the United States Congress. Said allegation by the College of Hospital Administrators and Healthcare Services and two economists, arises on the eve of the arrest of three doctors and three other people by the FBI. They were arrested due to a fraud scheme of Medicare for the amount of approximately 1 million dollar.

According to the article some people believe that said arrests affect the trust in Puerto Rico and the relationships with the Medicare program and that they will be adversely affect the request for more funds for said program, as well as to create bad publicity for the Island. On the other hand, others believe that said behavior should not be a reason to not assign more funds to the Medicare program in Puerto Rico, since there exists more fraud incidents in other states, such as the state of Florida and still they are assigned funds.

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