Health plan asks for removal of fraud advertisement – 06/24/2023 – Market

Health plan operators have started a movement to pressure technology giants in an attempt to take down content published on the internet linked to medical reimbursement fraud.

Last week, representatives of Abramge (Brazilian Association of Health Plans) sought out Google executives to present the sector’s concern with the advance in the volume of scams against operators, which has skyrocketed in recent years and reaches around R$ 3.5 billion, according to estimates by the entity.

The alert must also be taken to Meta, owner of services such as Instagram and Facebook.

In recent months, Abramge gathered hundreds of links from Google searches and posts from social networks with advertisements that insinuate possible fraud. The list contains contents that guide clinics and patients to circumvent the rules of the plans.

According to the association, one of the main irregularities involves aesthetic procedures, such as botox application, recorded as if they were medical appointments or other treatment covered by the plan.

“You can see advertisements that say that 100% of an aesthetic treatment will be reimbursed by the agreement. But the aesthetic procedure is not included in the reimbursement list”, says Simone Cesena, SulAmérica’s marketing director.

Amil claims that its intelligence tools against cyber threats have identified, in the last six months, 231 cases of fraud such as a false profile on a social network and fraudulent use of a brand, a number 86% higher than that registered in the previous semester.

In addition to trying to sensitize big techs, the sector has already taken cases to court. Amil claims that it currently has around 20 lawsuits in progress against clinics that are using its brand improperly in social media publications. According to the company, the clinics advertise the Amil logo posing as an accredited network to attract beneficiaries and then induce them to perform a practice known as assisted reimbursement, which is fraud, according to the operators.

“In recent sentences favorable to Amil, the offenders were sentenced to remove and stop using the Amil brand on their websites and social media and to pay amounts for moral damages”, says the company in a note.

In the so-called assisted reimbursement, clinics ask patients to hand over the login and password to access their health plan applications with the pretext of helping them in the process. When that happens, fraudsters can use the patient’s data to open fake bank accounts and request reimbursements for procedures not performed, just to extract money from the health plan, according to Cassio Ide Alves, Abramge’s medical superintendent.

In addition to asking Google to clean up the search results to remove this type of content, operators ask big tech not to sell sponsored links that advertise aesthetic procedures via health insurance.

An example: the so-called beauty chip —a hormonal implant that promises weight loss, cellulite reduction and increased disposition— is not covered by the plans, but Abramge found advertisements that offer the treatment indicating that it can be funded by the agreement.

The report of Sheet tested searches with terms related to performing aesthetic treatments paid for by the health plan, such as the expression “botox through the health plan”. In most cases, the Google search result already highlights that the practice may be illegal and there were no sponsored links.

Sought by the report, Meta replied that it does not allow fraudulent activities or any activities that violate its standards. The company also says it recommends people report profiles and ads that may violate platform policies.

Google highlights its policies that define how people and companies can advertise products through Google Ads and says it takes immediate action when it identifies a violation of usage policies. According to the company, when there are not enough elements to identify whether there has been a violation, it is up to the Justice to determine the removal of the content, in accordance with the terms of the Civil Rights Framework for the Internet.

The Marco Civil, however, is being questioned by actions in the STF (Federal Supreme Court). The theme would be judged in May, but the session was postponed and should stay for the second semester.

Abramge’s request may be granted if the contents violate the platforms’ terms of use and policies, but there is no obligation to withdraw, according to lawyer André Giacchetta, partner in the technology area at the Pinheiro Neto law firm.

“The removal is only mandatory from the moment the content is evaluated, and considered as really illicit or fraudulent, by a judge with an order determining the withdrawal”, he says.

Not all content denounced by Abramge has explicit scams, which should make it difficult for platforms to recognize it.

The problem is that part of the services disguised by fraud may involve procedures covered by the plans. It’s hard to spot the scam if a clinic claims it does a blood test to measure cholesterol, but actually uses the data to help put together a physical assessment and sports training.

Some products used for aesthetics may have medical use, such as botox, which helps fraudsters hide the practice. The toxin, best known for its function of smoothing wrinkles, can also be prescribed to treat problems such as migraines and bruxism.

The Bella Brazil clinic, for example, said that the advertisement on the networks mentioning “botox at no cost through the agreement” referred only to its use for medical purposes, not aesthetic ones. The Be Free clinic did not respond to the report’s contact.

For Ivar Hartmann, a law and technology researcher at Insper, the request from health plans could collide with the right to freedom of expression and end up harming customers.

“It is impossible to establish a system to meet what the plans ask for without manifestations that are not about fraud ending up being removed as a side effect”, he says.

“In many situations, the person who pays for the plan is at a disadvantage in terms of information. The plan knows everything, but the person does not, and ends up underutilizing it. The consumer deserves to receive as much information as possible, and that does not interest the plans” , says Hartmann.

The researcher points out that the health plan sector is not the only one asking for restrictions on internet content. Other segments, companies, NGOs and public bodies that have similar demands face the difficulty of big techs in creating specific filters because this would require more expenses and could raise questions about freedom of expression.

It’s easy to find tips on stealing credit card data or cloning a WhatsApp account, for example, in Google searches.

One of the few cases of success in content control was obtained by large media companies, in relation to copyright. There are systems that detect the misuse of music or excerpts from videos and films, which often block content that is banned at the time of publication.