Considering that the forms did not contain the minimum information required to fund the SUS, the 2nd Federal Court of Porto Alegre canceled the collection of reimbursement for ten cases in the public system of beneficiaries of Unimed in the state capital.
The National Supplementary Health Agency (ANS) charged the amounts related to hospital admission permits (AIHs). The health plan operator claimed that the amounts were not due, as the beneficiaries would have used the SUS procedures without the coverage of the contracts and the assistance would not have fulfilled the conditions for reimbursement.
Judge Daniela Tocchetto Cavalheiro noted that the AIHs were not really filled out correctly. Thus, it would not be possible to conclude that the information issued was true.
The audit reports produced by the operator showed the precariousness of the information contained in the medical records, the lack of certification of documents and the impossibility of tracking the materials used, proving the administration of medications, locating the physician responsible for ordering the tests or the results of them, among other irregularities.
“The Public Administration must use a rigorous audit system to assess the accounts of services provided within the SUS, in order to pay only what is effectively due. However, it cannot, on the other hand, be used of less rigorous and, therefore, distinct criteria, when it comes to indemnity to the SUS, by the health plan operators”, highlighted the magistrate. In addition to the ten canceled AIHs, there was an authorization in which the amount was only reduced.
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