Health plan refunds skyrocket and companies suspect fraud – 04/23/2023 – Panel SA
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To try to turn off the taps in the face of the crisis faced by the health plan market, the sector must raise scrutiny on the surge in the use of reimbursement. The suspicion is that the advance may be linked to fraud.
According to new data from Abramge (Brazilian Association of Health Plans), the reimbursement payment by companies, which did not reach R$ 6 billion in 2019, jumped to R$ 9 billion in 2021 and approached R$ 11 billion in the consolidated data for 2022.
The high is attributed to different factors, all linked to misuse, according to Marcos Novais, executive superintendent of Abramge.
Practices range from cases of doctors offering receipts camouflaging aesthetic treatments with botulinum toxin that should not be covered by the plan or splitting receipts with false dates to the use of facade clinics.
Joana Cunha with Fernanda Brigatti
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