Opinion Column – Fraudulent Medical Leaves

The recent revelation by the Office of the Comptroller regarding the 25,078 public officials who allegedly traveled abroad while on medical leave has sparked justified public outrage. However, this scandal is merely the surface of a problem with deep and complex legal ramifications—particularly for the private healthcare sector.

At the center of the debate is Article 110 No. 17 of Health DFL No. 1, which penalizes falsehood in medical certification. This offense, classified as a second-category economic crime under Law No. 21.595, can trigger the criminal liability of legal entities (clinics, medical centers, and other private healthcare providers) when effective Crime Prevention Models (CPMs) have not been implemented under Law No. 20.393.

And here arises a relevant tension: Who is truly required to comply with this legislation? The Economic Crimes Law (ECL) and Law No. 20.393 do not currently apply to municipalities or most state bodies, leaving many public institutions most involved in these cases outside the sanctioning framework. This has generated a sense of injustice and imbalance, especially in the private sector, which is exposed to severe legal, reputational, and operational consequences if it fails to properly implement its compliance system.

But beyond this regulatory imbalance, the truth is that the private sector cannot afford to minimize this risk—especially when collaborating with the State or participating in the public health system. Responsibility remains enforceable, and risks are present in every license issued without proper controls.

What other crimes could be involved?

The act of issuing or using fraudulent medical leave licenses can involve a wide range of offenses, all with consequences for legal entities when an effective Crime Prevention Model (CPM) has not been implemented in accordance with Law No. 20.393. Depending on the specific circumstances of each case, we could be facing:

1. Falsehood in medical certification

→ Art. 110 No. 17 of Health DFL No. 1 Second-category economic crime that triggers criminal liability if there is a lack of effective preventive controls.

2. Fraud against the Treasury

→ Art. 470 No. 8 of the Penal Code Applicable when undue public benefits are obtained. Affects FONASA, ISAPRES, and the State.

3. Fraud and financial deception

→ Arts. 468 and 473 of the Penal Code If there are undue charges, monetary benefits, or fraudulently justified absences.

4. Forgery and malicious use

→ Arts. 197 and 198 of the Penal Code

5. Bribery and corruption between private parties

→ Arts. 248 and ff., and Art. 250 of the Penal Code If money or benefits are given in exchange for issuing false licenses.

6. Criminal association and money laundering

→ Art. 292 of the Penal Code and Law No. 19.913 If organized networks or illicit money flows are involved.

What role does compliance play?

Compliance is not a formality—it is a living system of control and governance that must anticipate, prevent, detect, and respond to these risks. In this context, at least five key pillars must be reinforced:

1. Effective compliance governance:

Clinics, medical centers, and providers must demonstrate genuine top-level commitment to ethics and legality. A CPM without monitoring, resources, or independence is a dangerous simulation.

2. Proper risk management:

The issuance of medical licenses must be identified as a critical risk in risk maps. Lack of traceability, control, and medical review can lead to institutional criminal liability.

3. Due diligence for external professionals:

Many issuing doctors operate as independent third parties. Evaluating their background, behavior patterns, conflicts of interest, and subjecting them to compliance clauses is essential. Article 3 of Law No. 20.393, amended by Law No. 21.595, requires controls even over related external persons.

4. Effective training:

Medical and administrative teams must be familiar not only with clinical protocols but also with the crimes associated with their actions, the relevant legal articles, and institutional consequences. Ignorance does not exempt from liability.

5. Efficient whistleblower channel:

A culture of reporting is not built with empty boxes, but with effective responses, guaranteed anonymity, and clear corrective actions.

Risks for organizations:

Failure to comply with these duties can have devastating consequences for a healthcare institution:

• Criminal liability of the legal entity (Law No. 20.393)

• Loss of agreements with FONASA and ISAPRES

• Fines, closures, or prohibition from contracting with the State

• Prosecutorial investigations and regulatory interventions

• Reputational damage and loss of patients or providers

This case also highlights the urgent need to move toward a compliance model in the public sector, where serious regulatory, cultural, and operational deficits currently exist. The unequal application of the law between the private and public sectors creates perverse incentives and undermines the legitimacy of the system.

Incorporating prevention, control, and accountability mechanisms in public entities—especially municipalities and health services—is not just desirable, it is essential to restore trust.

The scandal of fraudulent licenses is not an administrative issue. It is a complex criminal phenomenon that threatens the credibility of the healthcare system. While the private sector responds with compliance and oversight, the State must move toward similar standards. Institutional ethics cannot depend on who is legally bound, but on a genuine commitment to legality and the common good.