Insurance companies owe Medical Center $16 million.

An investigation by the island Senate has revealed that insurance companies owe the Puerto Rico Medical Center in Río Piedras $16 million, Sen. Juan Oscar Morales Rodríguez said.

By THE STAR STAFF

Sen. Juan Oscar Morales Rodríguez announced Monday that a closed hearing will be held on Senate Resolution 431, which aims to investigate the use of $19.5 billion allocated to the Medicaid Program and the Vital Plan. 

The investigation has revealed that insurance companies owe the Medical Center in San Juan $16 million, the senator said in a radio interview. 

Two public hearings have been held, but the third was canceled after summoned providers expressed fear of retaliation. As a result, a closed hearing will take place.

Morales highlighted the critical finding that insurance companies collectively owe substantial amounts to key hospitals, including the $16 million to the Medical Center, and noted the surprising disparity between rates paid to private hospitals and those paid to public institutions. He also announced pending updates on debts owed to laboratories.

The senator emphasized that new legislation aims to standardize payment rates across the public and private sectors and to regulate how private insurers hire physicians.

He stressed the need for the Health Insurance Administration (ASES by its acronym in Spanish) to expand its staff to strengthen oversight of insurers and guarantee proper fund utilization.

“What struck me most was that the insurers […] were asking me for the government to audit them more because, when I asked them, ‘When was the last time ASES went there to evaluate, beyond the financial aspects, the medical processes, the things that are done?’ none of them could recall the date,” Morales said. “Unfortunately, ASES needs more resources. The office dedicated to this has seven employees. The question is whether, with seven employees, we can perform the oversight work we need to ensure that the money used in the health reform, which is millions of dollars, is being used appropriately.”

Morales also said island Health Secretary Víctor Ramos Otero will travel to Washington next week to advocate for Medicaid program funds, which expire in 2027.