INSS: Delay in expertise can generate payment of BRL 6.6 billion – 05/30/2023 – Market

The delay in carrying out medical examinations can generate an undue payment of BRL 6.6 billion in pensions for permanent disability in a period of one year, warns the TCU (Tribunal de Contas da União).

A financial audit carried out on the 2022 statements of the FRGPS (Fundo do Regime Geral de Previdência Social) detected a high number of overdue expertise for this benefit and a low number of reassessments conducted by the federal government, opening loopholes for irregular transfers.

The process is reported by Minister Jorge Oliveira and should be judged this Wednesday (30) by the plenary of the court of accounts.

The opinion of the technical area points to the existence of 2.9 million permanent disability pensions (called before disability retirement) that have not been reviewed for more than two years, as required by law.

Last year, only 3,547 biennial review inspections of this benefit category were carried out — equivalent to only 0.12% of the pending stock. From these analyses, 449 benefits were terminated (12.6% of the total submitted to medical expertise).

Armed with this data, the auditors simulated the potential for overpayments. If the percentage of 12.6% remains constant, it would mean that 367.9 thousand policyholders would be receiving transfers without being entitled to the benefit.

Considering the average value of retirement due to permanent disability (R$ 1,497.98), the damage to public coffers can be R$ 551.1 million per month and R$ 6.6 billion per year.

“It is clearly verified that the damming in the performance of medical expertise, in addition to consequences for the insured, has a direct impact on the FRGPS, in this case, generating a relevant amount of payment of benefits that could be stopped”, says the report prepared by AudFinanceira ( Audit Unit Specialized in Certification of Accounts).

“By the way, an annual loss of BRL 6.6 billion undermines the Fund’s sustainability and goes against the reforms that have been carried out in recent years, which, in itself, justifies the adoption of urgent measures to make the realization feasible. of expert revisions”, states the document.

The Federal Medical Expertise service is not linked to the INSS (National Social Security Institute), but to the Ministry of Social Security (in 2022, the period analyzed, the portfolio was called the Ministry of Labor and Social Security). According to the technical report, the “finding” on the expertise was forwarded to the managers, who did not manifest themselves.

The technical unit also states that it will propose a representation to “determine possible responsibilities for the failure to adopt measures for the timely completion of medical examinations to review the benefits of retirement benefits due to permanent disability”. Opening an investigation in this regard will need to be approved in plenary and, if confirmed, may result in administrative punishment of managers.

The financial audit will also support the court’s opinion on the 2022 BGU (Balanço Geral da União) for the purpose of issuing a prior opinion on the accounts of former President of the Republic Jair Bolsonaro (PL).

The delay in carrying out the expertise does not only affect pensions due to permanent disability.

As shown to Sheet, 1.05 million Brazilians were awaiting medical expertise in April this year. The number is 13.3% higher than in December 2022 (930.6 thousand) and represents a leap in relation to the average of 490 thousand requests awaiting scheduling in the first three months of last year.

The number is lower than that pointed out by the TCU because it reflects the expertise requested by policyholders, including those seeking initial recognition of the right to some government assistance.

The court of accounts, on the other hand, analyzes the benefits already granted and which should undergo reassessment because the two-year period for carrying out a new inspection has already expired – but its beneficiaries are not necessarily already in line.

The Lula government (PT) is facing an impasse because the medical experts demand the resumption of the payment of a bonus to expand the ability to analyze requests —which also increases their salaries.

Today, experts aim to complete 12 analyzes a day. In all, there are 2,900 experts, for an average monthly volume of 400,000 new requests that require medical expertise at the INSS —not counting periodic reviews.

According to the Social Security, the current number of servers is able to meet 95% of the monthly demand and is insufficient to attack the accumulated liabilities

Paying a bonus for extra analysis has been used intermittently since 2016 to speed up analyzes and increase the number of processes completed daily by each expert. Since the end of 2022, however, its payment has been suspended, due to the understanding that it was not possible to authorize the expense beyond the election year.

The resumption of bonus payments is seen by the government as a solution to solve the problem. Until December, experts received BRL 61.72 per extra analysis. That month, employees were able to complete 120,000 additional assessments.

However, the solution has not yet left the paper because the government fears pressure from other categories. The Federal Revenue has been paralyzing in an attempt to obtain regulation of the category bonus, instituted in 2017 and which until today only pays fixed amounts, lower than expected by the auditors.