{"id":17035,"date":"2026-05-02T15:31:43","date_gmt":"2026-05-02T18:31:43","guid":{"rendered":"https:\/\/impactocastex.com.ar\/?p=17035"},"modified":"2026-05-02T15:31:43","modified_gmt":"2026-05-02T18:31:43","slug":"una-auditoria-del-pami-detecto-un-esquema-de-sobreprecios-en-prestaciones-oftalmologicas","status":"publish","type":"post","link":"https:\/\/impactocastex.com.ar\/?p=17035","title":{"rendered":"Una auditor\u00eda del PAMI detect\u00f3 un esquema de sobreprecios en prestaciones oftalmol\u00f3gicas"},"content":{"rendered":"
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Otra vez irregularidades <\/strong>en el PAMI<\/strong>. Una auditor\u00eda interna<\/strong> en la obra social de los jubilados detect\u00f3 la existencia de presunto un entramado de maniobras irregulares<\/strong> en prestaciones oftalmol\u00f3gicas y \u00f3pticas <\/strong>que se repite en distintas regiones del pa\u00eds. El esquema incluye sobrefacturaci\u00f3n, pr\u00e1cticas inexistentes, derivaciones direccionadas y cobros indebidos<\/strong> a jubilados.<\/p>\n<\/div>\n

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La informaci\u00f3n surge de un informe reciente del mismo organismo, que se suma a investigaciones anteriores ya judicializadas y con sanciones administrativas en curso. <\/p>\n<\/div>\n

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El PAMI hab\u00eda sido objeto recientemente de reclamos por la falta de pago a los prestadores<\/strong> y un paro de 72 horas de los m\u00e9dicos de cabecera, en rechazo a una resoluci\u00f3n que elimina la consulta presencial como fuente de ingreso y los incentivos econ\u00f3micos a la formaci\u00f3n profesional. El malestar en el organismo gener\u00f3 cortocircuitos en el gabinete entre el ministro de Econom\u00eda Luis Caputo y Mario Lugones, de Salud.<\/strong><\/p>\n<\/div>\n

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El relevamiento -que adelant\u00f3 Infobae<\/strong>– se bas\u00f3 en cruces de datos del sistema de \u00d3rdenes M\u00e9dicas Electr\u00f3nicas (OME) y auditor\u00edas prestacionales, y permiti\u00f3 establecer que no se trata de episodios aislados<\/strong>. <\/p>\n<\/div>\n

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Los mismos patrones se identificaron entre m\u00e9dicos, \u00f3pticas y centros oftalmol\u00f3gicos en provincias como Santiago del Estero, Buenos Aires, Entre R\u00edos y La Rioja, adem\u00e1s de ciudades como Concordia. En esos puntos se registraron cientos de casos por prestador y una concentraci\u00f3n at\u00edpica de recetas en determinados profesionales, muy por encima del promedio nacional.<\/strong><\/p>\n<\/div>\n

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Desde el organismo aseguran que la atenci\u00f3n a los jubilados est\u00e1 garantizada <\/strong>y que el objetivo no es recortar prestaciones, sino desarticular los circuitos de fraude. Con sumarios en curso, causas penales abiertas y nuevas auditor\u00edas en marcha, el PAMI avanza sobre uno de los esquemas de irregularidades m\u00e1s extendidos detectados en su historia reciente.<\/p>\n<\/div>\n

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La auditor\u00eda describe al menos cinco modalidades de desv\u00edo<\/strong>. La m\u00e1s extendida es la sobrefacturaci\u00f3n de anteojos<\/strong>: se recetaban lentes de baja graduaci\u00f3n, correspondientes a m\u00f3dulos de menor valor, pero se facturaban m\u00f3dulos de alta graduaci\u00f3n, que pueden costar hasta cinco veces m\u00e1s. Mientras el afiliado recib\u00eda un producto b\u00e1sico, PAMI pagaba como si fuera uno premium<\/strong>. En n\u00fameros, un m\u00f3dulo real ronda los $4.941, pero se registraron facturaciones por hasta $27.204.<\/p>\n<\/div>\n

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Otra pr\u00e1ctica detectada fue la de las prestaciones fantasma<\/strong>: consultas, estudios de fondo de ojo o topograf\u00edas que nunca se realizaron. En algunos prestadores, hasta el 50% de las \u00f3rdenes carec\u00eda de historia cl\u00ednica. Tambi\u00e9n se observaron maniobras dentro del sistema, como facturar primeras consultas como controles -de mayor valor- y el uso intencional de c\u00f3digos para inflar montos.<\/p>\n<\/div>\n

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Un cuarto patr\u00f3n fue el de los circuitos cerrados con conflicto de inter\u00e9s<\/strong>. En estos casos, m\u00e9dicos derivaban sistem\u00e1ticamente a una \u00fanica \u00f3ptica, en varios episodios con v\u00ednculos familiares directos, garantizando un beneficio econ\u00f3mico cruzado.<\/p>\n<\/div>\n

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El quinto mecanismo descripto en el informe es el m\u00e1s perjudicial para los afiliados: el cobro indebido. Se les ofrec\u00edan lentes \u201cmejores\u201d fuera de cobertura a precios atractivos y terminaban pagando sumas elevadas por una prestaci\u00f3n que deb\u00eda ser gratuita. Al mismo tiempo, el lente est\u00e1ndar se facturaba a PAMI, lo que permit\u00eda cobrar dos veces. La auditor\u00eda document\u00f3 pagos de hasta USD 1.500 m\u00e1s $353.500 por anteojos cubiertos por el sistema.<\/strong><\/p>\n<\/div>\n

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Los auditores analizaron casos concretos<\/strong>. En Santiago del Estero se confirmaron 606 episodios de sobrefacturaci\u00f3n, con un perjuicio estimado en $ 10,4 millones en la muestra relevada y el 95% de las recetas derivadas a una misma \u00f3ptica. All\u00ed se comprob\u00f3 un v\u00ednculo familiar directo entre el m\u00e9dico derivante y el titular del comercio<\/strong>. En Mar del Plata se detectaron afiliados que pagaron prestaciones cubiertas y decenas de pr\u00e1cticas sin respaldo cl\u00ednico. En Entre R\u00edos, un profesional acumulo\u0301 m\u00e1s de 600 sobrefacturaciones, consultas sin historia cl\u00ednica y recetas m\u00e9dicamente inconsistentes.<\/p>\n<\/div>\n

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La investigaci\u00f3n forma parte de un proceso m\u00e1s amplio iniciado por el PAMI sobre el uso del sistema OME. Auditor\u00edas previas ya hab\u00edan expuesto simulaci\u00f3n de consultas, falsificaci\u00f3n documental y uso indebido de datos de afiliados<\/strong>. Actualmente existen al menos seis causas judiciales activas en distintas jurisdicciones federales, con imputaciones por estafa, falsificaci\u00f3n de documentos y defraudaci\u00f3n contra la administraci\u00f3n p\u00fablica.<\/p>\n<\/div>\n

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Otra vez irregularidades en el PAMI. 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