IGAS recalls that there was an alert, in 2022, by the person responsible for the administration of the area regarding deviations in additional surgical production in the Dermatology Service, but regarding the activity of the doctor in question, no alarm signal was made, neither the quantity nor the amounts paid and received, “although this was always known to the director of the service”.
The dermatologist who earned more than 700 thousand euros in additional surgeries at Santa Maria Hospital unduly received incentives for surgeries he coded, some oncological, concluded the who sent the report to the Public Ministry.
According to the conclusions of the report released by the General Inspection of Health Activities (IGAS), the dermatologist in question You will even have scheduled dermatology appointments for your parents without prior referralia, prepared the surgical proposals and performed the surgeries.
Part of the information released this Tuesday by IGAS had been revealed, on Monday night, by .
In the note released this Tuesday, IGAS recalls that there was an alert, in 2022, by the person responsible for the administration of the area regarding deviations in additional surgical production in the Dermatology Service, but regarding the activity of the doctor in question, no alarm signal was made, neither the quantity nor the amounts paid and received, “although this was always known to the director of the service”.
It was in July 2024 that, following the identification of a high amount paid to the doctor in question, the Santa Maria Board of Directors questioned the Human Resources Management Service, which justified the legality.
On November 14, 2024, according to the note from the general inspection, the Board of Directors, based on monthly information from the Human Resources Management Service regarding payments made in additional production, reported to October 2024, decided to consider for payment to surgical teams “only the price for severity level 1 of the respective GDH[patientclassificationsystem}”[sistemadeclassificaçãodedoentes}”
At the time, surgeries in additional production were restricted to oncological situations and the amount paid by GDH to the team dropped from 55% to 45%.
In the analysis carried out for the period between 2021 and the end of the first quarter of 2025, in the Santa Maria Dermatology service, the surgical proposals “were not included in the Integrated Surgery Registration Management System (SIGIC) when the consultation was carried out, being registered only on paper, “which distorted the list of those registered for surgery, as it did not reflect seniority“, says the general inspectorate.
It also says that the targeted dermatologist (Miguel Alpalhão) issued and approved 450 surgical proposals and issued, approved and codified the same surgical procedure in 356 episodes, a practice that was prohibited by the Board of Directors in August 2024.
More than 700 thousand euros in surgeries, many poorly classified
In the period under analysis, the dermatologist earned 714,176.42 euros for the surgical activity carried out in additional productioncarried out outside normal working hours, on weekly rest days or holiday compensation.
IGAS concludes that the clinical acts analyzed in the sample were actually carried out, but the procedures “could not have been remunerated through SIGIC, as they did not have a framework“, but rather through another form of payment, such as overtime work.
He further concluded that the incentive for malignancy was unduly attributed in a percentage of 19.7% of the surgeries analyzedin the case of the doctor targeted, and 33.3% in the case of the Dermatology service.
It also points to “improper coding” of additional comorbid diagnoses that led to grouping at severity level 2, in minor surgeries that did not use sedation, anesthetic monitoring or recovery stay.
IGAS also points to the lack of biometric entry and exit records in the attendance control systems, “required for the activity carried out in additional production and for the respective payment” and concludes that the internal control mechanisms for outpatient surgery in additional production at the Santa Maria Local Health Unit are ineffective.
The investigation process continues, to prepare information related to the possible financial responsibility of those involved in the processes relating to undue payments, which will also aim to “exactly determine the differences between the amounts that were unduly remunerated as outpatient surgery and those that should have been paid for the activity actually carried out in minor surgery”, it states.
In addition to being sent to the Public Ministry, the report was also sent to the office of the Minister of Health, the Board of Directors of Santa Maria, the doctor concerned and the Board of Directors of the Central Administration of the Health System.
