Colombia Freezes Health Payments After Regulator Flags Inflated Claims

Colombia’s public health system runs on a chain of payments that leaves hospitals owed billions of dollars. The new government has now halted part of one monthly transfer, saying some of the bills do not add up.

Colombia’s government has frozen 38,724 million pesos (about US$12.1 million) in health payments while it checks the claims behind them. Miller Soto, the presidential spokesperson, said on 20 September that 26 providers had been temporarily excluded from the transfer.

Why This Matters

Colombians get most of their care through health insurers known as EPS, which receive public money for each member. Those insurers then pay the clinics, hospitals and suppliers that treat their members.

The chain is deeply in debt, with EPS owing about 41.5 trillion pesos (US$13.0 billion), El Tiempo reported on 5 September. It said 92.6% of that debt was more than 60 days overdue and 315 public hospitals were in fiscal rehabilitation.

Nine insurers are under state intervention, including Nueva EPS, the largest, with 11.39 million members, El Heraldo reported. Nueva EPS alone owes 21.37 trillion pesos (US$6.7 billion), according to El Tiempo.

President Abelardo de la Espriella took office on 7 August 2026 after winning a June runoff with 49.66% of the vote. On 5 September he said intervened insurers that are not viable “must be liquidated in an orderly way”.

How Direct Payment Works

Adres is the state agency that administers the resources of Colombia’s health system. Under a scheme called giro directo, or direct payment, it sends money straight to providers rather than through the insurers.

Each month, insurers in the subsidised regime, which covers lower-income Colombians, submit requests naming the providers they owe. Adres then pays those providers the amounts listed, according to the health-sector publication Consultorsalud.

The National Health Superintendency, known as Supersalud, supervises the insurers and can review the requests before money moves. That review is where the September problem surfaced.

What Supersalud Found

Supersalud said on 16 September that it had found inconsistencies in some September direct-payment requests. Some requested amounts exceeded the obligations the insurers had recorded, El Espectador reported.

Some requests also sought funds for third parties with no evident debt, according to the regulator. Other requests showed large swings from the insurers’ average monthly costs in 2026.

The regulator also cited weak internal checks at some EPS and poor documentation for certain debts. As a precaution, it temporarily excluded 26 providers and suppliers of health services and technologies from the process.

The aim is to stop system money moving while the reported information is verified, the regulator said, El Universal reported. Neither the regulator nor the government has named the insurers or the 26 providers.

What the Government Says

The presidency took the findings public on 20 September through its spokesperson, Miller Soto. “Health money does not belong to an EPS, a clinic or an intermediary,” Soto said, according to El Tiempo.

“It belongs to whoever is waiting for an appointment, a medicine or surgery,” he added. He said the government would not pretend that 38 billion pesos (about US$11.9 million) was a simple typing error.

“What cannot be proven will not be paid,” Soto said. María Andrea Godoy, a lawyer with about 30 years in the health sector, has headed Supersalud since late August.

A System Already Under Strain

The freeze lands on a system in which hospitals rely heavily on insurers that often pay late. El Tiempo reported that 78% of hospitals depend on EPS funding.

The previous government, under Gustavo Petro, tried and failed to pass a health reform through Congress. A Senate committee shelved it for a second time on 16 December 2025, by eight votes to five.

The new government has ruled out a fresh reform bill and will recalculate per-member payments instead, El Heraldo reported. Petro has warned that if the EPS are liquidated, they will not pay their debts to hospitals.

The Scale in Context

The frozen sum equals less than 0.1% of the debt that EPS owe, based on El Tiempo’s figures. Supersalud has asked insurers and providers for documents that trace each obligation, El Espectador reported.

Providers stay excluded until the authenticity of the debts is verified, according to El Tiempo. No timetable for that review has been published.

Dollar figures use Colombia’s official TRM exchange rate of 3,192.92 pesos per dollar, valid on 21 September 2026. The Financial Superintendency calculates and certifies the TRM from the previous day’s dollar trades.

No Finding of Wrongdoing

Supersalud has described its findings as inconsistencies, not as proven fraud. No insurer, clinic or supplier has been charged, and none has been named in public.

The regulator said it may request more information when requests lack support, before letting the process continue. Because the parties have not been identified, none has been able to respond in public.

What It Means If You Live or Invest in Colombia

For patients, the measure covers payments tied to 26 providers, not the whole September transfer. Anyone treated at a clinic contracted by an EPS should watch for delays if that clinic is among those excluded.

For investors in hospital groups or drug distributors, the case points to closer scrutiny of money owed by EPS. Suppliers that rely on direct payment should expect stricter document checks before money is released.

Expats with private prepaid plans, known as medicina prepagada, are outside the subsidised regime at issue. The larger risk remains the fate of the intervened insurers, which the president says may be liquidated.

What Is Not Yet Known

It is not known which EPS filed the flagged requests or which 26 providers were excluded. The government has not said how long the checks will take.

It is unclear whether any case will be referred to prosecutors or other oversight bodies. The size of the full September direct-payment transfer has not been published alongside the frozen amount.

The government has not said whether earlier months’ requests will also be reviewed. Nor has it said which intervened insurers it considers viable.

More: Colombia news in English, every day from The Rio Times.

Sources: El Tiempo, government freezes the Adres transfer, Infobae, Miller Soto’s statements, El Espectador, Supersalud’s findings, Consultorsalud, the 26 excluded providers, El Tiempo, De la Espriella on intervened insurers, El Heraldo, the nine intervened EPS, El Tiempo, Senate committee shelves Petro’s reform, Banco de la República, the TRM exchange rate

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