Scandal at SeNaSa: Million-dollar payments for non-existent medical services detected
An exhaustive audit conducted by the National Health Insurance (SeNaSa) has uncovered a network of irregularities involving general surgeon Elsa Evelyn de la Rosa Vásquez. According to the file presented by the Public Prosecutor’s Office within the framework of operation COBRA 2.0-A, the professional allegedly received more than two million Dominican pesos for procedures and consultations that were never performed on the registered patients.
The report details that the total amount of the questioned claims reaches RD$2,052,051.20. After a detailed analysis of the files, the investigators found serious inconsistencies that point to a structured fraud scheme:
- Incomplete claim forms lacking proper identification of the service provider.
- Affiliate signatures displaying handwriting suspiciously similar to that of the person completing the documents.
- Alteration of contact phone numbers in the records.
- Inclusion of notes on medical authorizations with specific names linking these files to other cases under investigation.
The authorities have identified ten affiliates listed in the claims filed by the doctor, who have formally declared that they have not received any type of medical attention from the professional.
Ongoing judicial process
This finding is a central part of the Public Prosecutor’s Office’s accusation, which seeks to dismantle a criminal network organized from within the insurance entity. Mirna Ortiz, a representative of the Public Prosecutor’s Office, described the situation as a complex scheme in which former SeNaSa employees participated in complicity with doctors who used their assigned codes to validate fraudulent charges.
Currently, the judicial process is at a critical stage. Judge Rigoberto Sena has scheduled the coercion measure hearing for the 26 individuals involved in the network for next Wednesday, September 23rd. The prosecuting body has requested that the case be declared complex and that pretrial detention be imposed for a period of 18 months for the doctors and collaborators named in the file.
Among those indicted, in addition to Elsa Evelyn de la Rosa Vásquez, are various medical specialists, such as gastroenterologists and surgeons, who must answer to the justice system for their alleged involvement in this structure that affected public funds intended for the health of the Dominican population.
