The audit documented specific cases. In Santiago del Estero, 606 cases of overbilling were detected, with a loss of $10.4 million in the sample analyzed and 95% of the prescriptions derived from the same perspective, related to the family member of
the referring physician.In Mar del Plata, an ophthalmological center combined undue charges to members with 58 benefits without a medical history. In Entre Ríos, a professional recorded 613 cases of overbilling, 151 consultations without clinical support and 16 prescriptions without
diopters.The scheme was also identified in La Rioja and Concordia, where 830 cases were recorded concentrated on a single doctor.
These irregularities are part of a larger investigation into the OME system, which has already resulted in at least six active judicial cases initiated by the agency and the Specialized Fiscal Unit (UFI-PAMI). The maneuvers include unsupported billing, document falsification, and misuse of affiliate data
.The audits also revealed volumes of benefits incompatible with any real medical practice. In gastroenterology, 283 practices were declared in five hours, while in cardiology, 689 orders were registered in a single day, which would involve
working hours of up to 108 hours.The survey is part of the comprehensive review process initiated by the current leadership of the PAMI, led by Esteban Leguízamo since December 2023, which seeks to dismantle fraud mechanisms and make the use of system resources transparent
