In less than two and a half years, the Puerto Rico Health Insurance Administration, known by its Spanish acronym, ASES, has sanctioned First Medical Health Plan with five fines totaling nearly $4.8 million. But the company has paid only $300,000, according to data provided by the agency.
That is because three of the fines remain in administrative proceedings before ASES. One of them has been in that process for more than a year and a half.
The agency disclosed the information after an investigation by the Centro de Periodismo Investigativo (CPI) revealed that First Medical had maintained a years-long pattern of nonpayment to doctors and service providers. In March, ASES Executive Director Carlos Santiago Rosario refused to answer questions about the fines against First Medical. A month ago, the CPI requested information on ASES fines against all health plans, but the agency provided only the fines against First Medical last week. The agency delivered information about the other insurers on Tuesday, showing that First Medical has incurred the most fines among insurers over the past three years.
Ultimately, Santiago Rosario took more than two months to provide the CPI with information on the fines against First Medical. Since then, he has not been available to answer the CPI’s questions on the matter, including why the process of imposing the fine — which began under the previous government administration — has moved so slowly.
The ASES executive director also did not answer questions about the status of payments to providers. In 2025, the company reported $170.7 million in unpaid claims, according to its annual report to the Office of the Insurance Commissioner.
Before joining ASES, Santiago Rosario worked for the Artau family — the owners of First Medical — as executive director of Metro Pavía Health Services until March 2025.
“If we have any process at this moment, I could not speak about it because it would be an ongoing process, if there were one. But as for a final fine that I have signed since I have been here, since July [2025], I have not signed any final fine against them,” Santiago Rosario said in late March in an interview with the CPI. After the CPI investigation was published, Santiago Rosario told El Vocero that he had issued multimillion-dollar fines against First Medical over failures to comply with reports audited by ASES.
The Fines
So far in this four-year government term, ASES has issued two fines against First Medical: one for $1.8 million for failing to pay providers and another for $1.4 million for failing to submit metrics related to the insurer’s call center performance. Both are under administrative review at ASES, so they are not yet final. The fines stem from violations the agency identified between 2023 and 2025. In other words, ASES took more than three years to fine the insurer over some of the violations.
Asked why ASES took so long to impose the fines, Health Secretary Víctor Ramos Otero said, “this has a process” and that “the entire investigation has to be done” to prevent insurers from challenging the fines and prevailing on technicalities.
“This [issuing fines] is not the only thing ASES has to do. ASES has to maintain the program [Plan Vital],” the secretary said. Plan Vital is the Puerto Rico government’s publicly funded health insurance program, which provides coverage to about 1.3 million beneficiaries.
First Medical paid two fines in November 2024 — one for $120,000 and another for $180,000 — for failing to pay provider claims, according to data provided by ASES. That same month, the agency imposed another sanction for the same violation, this time in the amount of $1.2 million. That fine has been in administrative proceedings for more than a year, unlike the two previous fines, which took about seven months from the date of imposition to the insurer’s payment. All three fines were imposed by former ASES Director Roxanna Rosario.
The former executive director said in an interview with the CPI that the insurer challenged the most recent fine through the administrative review process and that it was up to the new administration to follow through. The fine came after the insurer improved “significantly in 2024, approximately during the July-to-August period” in meeting provider payment requirements, but then “relapsed” and “had not achieved the provider payment compliance required.” The law requires invoices to be paid within 30 days.
“Insurers will always challenge every fine you impose on them, so those fines will be challenged, and they keep going up and escalate it to the [Court of Appeals] and reach the [Supreme] Court. We are going to defend the fines that are imposed,” the health secretary said in response to CPI questions about First Medical during a news conference at La Fortaleza, the governor’s mansion.
The CPI contacted First Medical, but the insurer declined to answer questions.
“It is First Medical’s policy not to comment on or disclose details related to ongoing administrative or regulatory proceedings, to preserve the integrity of those processes and respect the formal procedures established by the corresponding agencies,” César A. Ramírez, First Medical’s vice president of operations, said in written statements.
Asked whether First Medical has paid or still owes sanctions imposed by the previous administration, Ramos Otero said the prior administration “usually gave in and negotiated the fine.” He said, for example, that the government never collected the fines imposed in 2023 on the four Plan Vital insurers — MMM Multihealth, Triple-S, Plan de Salud Menonita and First Medical — for a combined total of more than $300 million. The fines were tied to alleged violations involving payment of the minimum rates established for contracted medical services.
“In the end, they gave in and did not collect a single cent of those famous $300 million. That was just for show, and people did not get paid either,” Ramos Otero said.
As of publication, Edna Marín, the other former ASES director who issued the 2023 fine notice, was not available to respond to the health secretary’s remarks.
First Medical Salud President Resigns
Amid these developments and after the CPI investigation was published, attorney José Valentín Cameron resigned in early May as president of FM Salud, the division of First Medical Health Plan that oversaw the company’s Plan Vital operation. Valentín Cameron remains with the company as a consultant to the president of First Medical Health Plan while he turns to teaching, the company said in a news release.
Asked about the reasons for his departure, Valentín Cameron told the CPI in written statements: “My resignation from FM Salud responds to a process of entering academia that has required years of preparation and professional reflection. This decision has been accompanied by a carefully planned operational transition, which has been carried out in a structured manner and reached its culmination in recent months, ensuring the continuity and stability of functions for the organization’s operational well-being.”
After Valentín Cameron’s departure, the insurer changed the plan’s corporate structure, creating a lower-ranking position overseeing Vital called “strategic director of the Medicaid segment.” Attorney Jessica Losa Robles was appointed to the post, and attorney Carlos O. Santana Marrero was named chief legal and regulatory affairs officer.
This translation was generated with the assistance of AI and reviewed by our editorial team to ensure accuracy and clarity.
