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Prepa defends health contract awarded to highest bidder

By on December 9, 2019

Prepa Exec. Director José Ortiz: “This reminds me of [the movie] ‘Weekend at Bernie’s.’ Every time there is something, they bring in Elías Sánchez.” Courtesy/Alvin Baez

The executive director of the Puerto Rico Electric Power Authority (Prepa), José Ortiz, defended Monday the awarding of the health insurance contract to the highest bidder, Triple-S, and ruled out that the decision to choose the insurer responds to links with Elías Sánchez Sifonte, who was confirmed to be the lobbyist for the health insurance company during the bidding process for the government’s Vital health plan.

Ortiz’s expressions come after complaints that the $42 million contract was awarded to the insurance company even though its proposal had the highest in cost, by $5 million, and proposed lowering benefits to Prepa employees. It is the second time Triple-S has received this contract even though the company presented the highest cost for the public corporation in the request of proposal (RFP) on both occasions.

“The Fiscal Oversight Board is currently evaluating this contract. We have requested additional information from the Electric Power Authority [Prepa] to complete this analysis,” the fiscal board responded to Caribbean Business’ inquiry about its position regarding the healthcare contract awarded to Triple-S and its compliance with the projected $29 million in healthcare savings established in the fiscal plan that was certified in June 2019.

“This reminds me of [the movie] ‘Weekend at Bernie’s.’ Every time there is something, they bring in Elías Sánchez. We haven’t heard [anything] about Elías Sánchez for a year and a half. At least I haven’t seen him anymore,” the executive director responded to press questions.

The 1989 comedy film he referred to is about two friends and co-workers, who discover evidence of fraud at the insurance company they work for, and their boss, Bernie Lomax, rewards them with a stay at his luxurious island beach house. When they arrive to his property, they find him dead. Little do they know that Bernie is the perpetrator of the fraud they’ve uncovered and is arranging to have them killed after he left the island. To stay alive, they try to convince the unknown killer that Bernie was alive as well.

“Triple-S has been with the Puerto Rico Electric Power Authority for many years and still a bid was held. To give you a hypothetical example, if you have a health plan that costs you $10 million and you are going to change it for another one, the claims that are in process, which have not reached the plan, have to be assumed by the agency. And there is talk that between one and the other there is a difference of one and a half million or so or two million [dollars], but those are the claims that are still running. If you change your plan, which seems to be cheaper, you must add the claims that are running to that new plan,” he stated.

“The medical plan for the employees of the [Electric Power] Authority is very important. More now that, we will have a clearinghouse that will decide about the medical plan in the coming months. You know we are going to bring in a privatizer and they will decide on the medical plan. So, making a change now, to make another change later, when it doesn’t save us money, it’s not worth it,” Ortiz concluded.

Popular Democratic Party (PDP) Rep. Jesús Manuel Ortiz took to social media to denounce that at the Health Insurance Administration (ASES by its Spanish acronym) there are already federal defendants favoring third parties with money that should be directed to the government health plan.

“There is federal investigation on the bidding [process] for the Vital plan, and now we see Prepa’s pattern to repeatedly renegotiate, choose the most expensive offer and reduce benefits to the insured,” he said.

When asked by Metro newspaper, Ortiz said this new contract could be challenged by any of the insurance companies that did not prevail in the RFP. In fact, the first bid was challenged by healthcare company Medical Card System Inc. (MCS) in 2018 because Prepa did not grant the contract to the less expensive offer and it considered elements not specified in the RFP document.

However, on Jan. 29, 2019, the Puerto Rico Court of Appeals validated the results of the bid.

The legislator also requested Puerto Rico Gov. Wanda Vázquez Garced to investigate the Triple-S contract deal with Prepa.”What will the Governor do to prevent more irregularities from happening with the new federal allocation (12 Billion) for the health plan? Will you also put the responsibility on the Fiscal Oversight Board? Will the government allow third-party profit at the expense of essential services such as the health plan? The governor has to explain to the country how she will ensure an honest handling of the money to take care of people’s health services.”

“What cannot happen is that third parties continue to profit at the cost of essential services, such as the health service,” he concluded.

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