SUS charges R $ 450 million from Hapvida and NotreDame

The health plan operators Hapvida and NotreDame Intermédica , which are negotiating the merger of their businesses, did not pay just over R $ 450 million to the Unified Health System (SUS). the quantity refers to the reimbursements that non-public plans must make to the govt when their clients are served within the public network.

The data are from the National Supplementary Health Agency (ANS), the body liable for inspecting the plans.

A survey by the municipality shows a balance of R $ 229.6 million due by NotreDame, and another of R $ 221.6 million, charged to Hapvida. Among the five largest plan operators within the country, they're the sole ones with an efficient Payment Index (IEP) of 0%.

The indicator, created by ANS , reflects the share of amounts paid or in installments in reference to the entire supposedly due by the businesses. the opposite three main operators within the country in number of beneficiaries - Bradesco Saúde, Amil and Sulamérica - appear above 99%.

This data has been accumulated by ANS since 2001, but the consolidation process has become more robust within the past five years.

When the beneficiary of an idea is assisted within the public network, the health unit makes the required identification and forwards the values ​​of the service to the ANS, which charges the reimbursement administratively. Once paid, the quantity is shipped to SUS. In 2019 alone, quite R $ 1 billion was transferred.

The reimbursement was the topic of questioning by operators, but the difficulty ended up pacified last year by the Federal Supreme Court (STF), which determined that companies must pay SUS. Still, some still afflict the gathering format and postpone the amounts due.

According to industry sources, Hapvida and NotreDame choose to not make payments and discuss it in court. For this, they create judicial deposits in amounts like the gathering, thus avoiding any sort of confiscation.

In a note, NotreDame said it owes nothing to SUS. consistent with the corporate, payments considered due are made directly by its affiliates, while those considered unfounded are discussed in court, through guarantee deposits.

Among the affiliates mentioned by the group, the ANS panel shows Santamália Saúde with a 44% IEP and R $ 13.6 million paid up to June 2020. Samed, on the opposite hand, has 100% discharge, with payments of R $ 3.6 millions. These values, however, don't interfere with the holding company's index and are faraway from the entire amount claimed by the agency.

Specialist within the subject, lawyer Ricardo Ramires, partner at Dagoberto Advogados, explains that there are still many doubts associated with collection, among them the worth of the services provided by the general public network.

According to him, the operators claim the payment of the SUS table, while ANS uses a table with values ​​50% higher. There also are contractual inquiries, like cases of consumers using the general public network during the grace period of the plan.

Representing Hapvida, The Brazilian Association of Health Plans (Abramge) claimed that disagreements associated with the shape and amounts of charges have led the operator to choose payment in court.

“Judicialization isn't an idea operators' strategy, but a right. additionally, the amounts are 100% provisioned in accordance with current legislation, including any interest, fines and monetary restatement ”, argues the entity.

When the payment of reimbursement isn't made, ANS seeks the Attorney General's Office (AGU), which is liable for representing SUS in court within the collection of amounts.

The evaluation at ANS is that, thanks to the characteristics of the businesses, which have a vertical network and with more controlled access, many purchasers find yourself opting, at just one occasion or another, for SUS. With that, the operators reduce the accident rates, which might be positive for business.

Since the announcement of negotiations for the merger, the 2 operators have registered an appreciation of R $ 32.5 billion in B3. Together, Hapvida and NotreDame reached a market price of R $ 129.4 million on Monday.

The new company would have 7.1 million insurance users and another 5.3 million dental plan users. Its own network would contains 300 clinics and 70 hospitals. The deal will still be analyzed by the executive Council for Economic Defense (Cade).

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