Health plans: cascading crisis generates R$ 1 billion in delays – 05/07/2023 – Market

The health plan crisis, which closed 2022 with an operating loss of BRL 11.5 billion, the worst level measured by the ANS (National Supplementary Health Agency) in 20 years, causes a ripple effect in the market and could get even deeper than the sector’s indicators indicate.

Distributors and importers of products such as prostheses, heart valves and other special materials used in treatments and surgeries say that cases of non-payment for the goods they sell to health plans and hospitals are underreported. The hospitals themselves also complain about the delay and blame the plans for extending the deadlines.

According to Abraidi (Brazilian Association of Importers and Distributors of Health Products), the practice of billing retention has grown in the last year, that is, the supplier delivers a knee prosthesis or a stent for surgery, but the buyer, which may be the health plan or the hospital, requires him to delay the issuance of the invoice, keeping the transaction without official registration for a longer time.

According to a survey by the entity with around 300 associates, there are more than R$ 1 billion in sales whose invoices have not yet been issued, an increase of almost 50% in relation to the survey carried out a year ago. Still according to the survey, the average time until the invoice is issued is around 48 days, but some suppliers say they have cases delayed for more than six months.

Abraidi claims that suppliers submit and agree to postpone billing because it is a very fragmented sector, with numerous small and medium-sized regional distributors, who are afraid of commercial retaliation from buyers, who are generally larger companies, with strong purchasing power.

“This happens after the surgery has been performed, and the patient has returned home cured. It’s not that the supplier can’t charge. He can’t even issue the invoice for what was used in the surgery. For us, that represents an extremely long delayed receipt. If I take 90 days to bill and another 120 to receive, my receipt period is 210 days”, says Sérgio Rocha, president of Abraidi.

Hella Gottschefsky, legal director of the association, says that the practice postpones the acknowledgment of debts with suppliers, which can generate a false positive impression on the balance sheets of hospitals and plans. The entity says that it is gathering data to denounce it to the CVM (Securities and Exchange Commission) and that it sees analogy with the case of Americanas. Questioned by the report if the problem has attracted attention, the CVM says that it monitors information and movements, taking appropriate measures when necessary.

The ANS states that it does not interfere in the dynamics of the relationship between the operator and the provider, but assesses that the delay of bills, by itself, does not generate an impact on the loss ratio because a provision is estimated.

“Even for those expenses not yet communicated (occurred and not notified), operators estimate, based on their history, the expectation of notice thereof, provisioned in the financial statements (provision for events that occurred and not notified). This process does not depend on the note. taxation”, says the ANS.

The other part of the suppliers’ concern is with tax inspection at a time when the government is intensifying its efforts to seek alternatives for lost revenue.

The fear among suppliers is that they will be fined for tax evasion, since the goods circulate without issuing a note. In addition to the state ICMS, the concern includes the incidence of federal taxes, such as Corporate Income Tax, Social Contribution and Pis/Cofins.

According to Abraidi data, of the total R$ 1.1 billion in retained earnings, almost R$ 503 million correspond to products delivered to private hospitals and more than R$ 470 million come from health plans, health plans and insurance companies. SUS covers another R$ 111 million. The problem represents 12% of the revenues of distributors and importers associated with the entity.

Antônio Britto, director of Anahp (association of private hospitals), says that the scenario is even more complex. “The reality is that we are facing a moment of crisis in the whole system, where the plans, to improve the cash flow, have been delaying the payment to the hospitals. And the hospitals cannot pay the suppliers without having received it from the health plans” , it says.

Among the hospitals linked to Anahp, the disallowance indicator, which are the questions made by the plans to the invoices sent by hospitals and service providers, rose by more than 20% between 2021 and 2022, and the average receipt period grew by 7%, to 73 days.

Abramge, an association that brings together health plans, says that companies have a regulatory obligation to provision 100% of amounts not yet paid.