Recently, internal audits and investigative reports of Costa Rica’s Social Security department (Caja), which funds the country’s sorely flawed universal healthcare system, have shown some serious expenditure increases on medicinal procurement in the recent past. It has been discovered that Caja has been purchasing “emergency orders” of medicines for upwards of ten times the normal price.

So, whether or not an inventory management problem or if certain administrators in Caja are in cahoots with certain drug companies to embezzle gobs of money, there is a serious problem. Caja drug stores were down by about 1/4^th of their normal amount, which is strange considering the fact that the drugs that were low on supply and needed to be rush delivered at elevated prices were drugs that have a foreseeable need. Most were cancer and AIDS treatment drugs. According to the internal audit, nothing was out of normal with patient needs. So why was Caja so low on medicine stores and in need of emergency deliveries?

The most extreme example of this is Caja’s purchases of medicine called Oxalipatino at exorbitant prices. Agents of Caja responsible for the procurement of medicines purchased 3,190 units of the drug for 158.96 dollars per unit ($523,100). This is over ten times the price of $14 per unit that Caja pays for Oxalipatino when buying from their normal source. Yes, this $476,200 price increase was from a different pharmaceutical company than usual and the prices were jacked up because of the fact that it was “emergency deliveries”.

The period in question ran for about a year and a half starting in 2010 under Ubaldo Carrillo. It was also discovered that the manager of Selah Medical Supply and the treasurer of Seven Pharma (one of Caja’s irregular, more expensive suppliers) was the mother of one of Caja’s medicine procurement employees and is currently under investigation.

Especially after the fact that Caja has had past multi-million dollar contribution “shortfalls”, it should not be thought that it is quite possible that some Caja administrators let storeroom drug supplies run low to have need — or an excuse —  for overpriced special deliveries through select sources. But where there is smoke, there is fire. And sometimes where there is fire, there is lined pockets.