Overview
- Internal reviews identified simulated consultations, unsupported billing, forged documentation, and misuse of affiliates’ personal data.
- New controls now in force require use of the digital appointment system, monitor service thresholds, and maintain continuous audits of provider conduct.
- Reported losses are described as multimillion in scale, though investigators have not yet determined a final figure.
- Alleged schemes include nonexistent OME orders billed as completed services, fake e‑prescriptions dispensed by pharmacies, and manipulation or sharing of professional credentials.
- PAMI says penalties will range from administrative sanctions to criminal complaints, with beneficiaries’ access to care guaranteed during the enforcement push.