INSS: Lack of remote expertise goes against the law, says TCU – 05/17/2023 – Market

The TCU (Union Court of Auditors) concluded, in a trial held in April, that the INSS (National Social Security Institute) failed to comply with the law by not implementing remote medical expertise during the Covid-19 pandemic.

The measure can be considered unconstitutional for having disrespected the principles of efficiency and human dignity, says the report. In the document, the agency states that “the non-institution of expertise through remote channels as a measure to increase the pace of medical expertise and, consequently, reduce the period of payment of the benefit for temporary incapacity” contravened article of law 8.213, of 1991 .

The TCU’s decision, which determines the INSS to implement tele-expertise to respond to requests for disability benefits and the release of the BPC (Continued Provision Benefit) paid to disabled people from needy families, is the result of an action by the CNJ (Council Justice) proposed still in 2020.

According to Adroaldo da Cunha Portal, secretary of the General Social Security Regime, the Ministry of Social Security is preparing to implement the teleexpertise in the second half of this year, after a pilot experience carried out in 2022, also by determination of the TCU, showing positive results.

The ministry awaits, according to him, a legal solution for the measure, which collides with guidance from the CFM (Federal Council of Medicine) and the resistance of medical experts from the INSS. According to the secretary, the body’s 2020 resolution says that “telemedicine applied to teleexpertise is an ethical infraction”.

The Previdência pilot project carried out last year involved 400 medical examinations carried out via telemarketing. There was an expectation that, in 70% of the cases, there would be some result based on the medical examination, be it granting or refusing the benefit.

“Pmut’s intention [Perícias Médicas com Uso da Telemedicina] was to assess whether telemedicine applied to teleexpertise would be successful. This experiment showed that in 94% of the cases of the 400 medical examinations, the physicians were able to form a diagnosis and make a decision, much higher than initially expected. In only 6% of cases did the doctor prefer to refer the applicant for an in-person examination, but that was because the internet was down”, says Portal.

While the new modality is not implemented, the government prepares the payment of bonuses to medical experts, which must be implemented through a provisional measure. Negotiations on the amounts, however, are still ongoing.

The idea is to increase the number of inspections from 12 to 18 per day, and that they are also carried out on Saturdays. If teleexpertise is implemented, the bonus would have a lower value, but the exams could also be carried out on Sundays and after hours, says the secretary.

In 2022, a joint effort to carry out an investigation paid a bonus of BRL 61.72 per examination. Now, a higher value is discussed. Today, according to Portal, there is a queue of 1.050 million unfulfilled skill requests.

Understand the TCU process

Between March and September 2020, the INSS kept its branches closed across the country, as a way of protecting against contamination by the coronavirus, providing assistance to policyholders at a distance to grant various benefits, but without carrying out medical expertise, holding back the release illness and accident benefits, in addition to disability retirement.

With that, the CNJ proposed the action. At the time, the queue for administrative benefits at the INSS reached 600,000. In court, there were more than 200,000 lawsuits dammed up, according to counselors Maria Tereza Uille Gomes and Henrique de Almeida Ávila, authors of the action. In a few months, however, it would reach almost 1 million dammed benefits.

With the closure of the agencies in the pandemic, the possibility of sending the medical certificate through the My INSS for remote analysis was implemented, but without the citizen being able to be seen by an online doctor, through the principle of telemedicine, as the TCU wants.

For Henrique Ávila, former councilor of the CNJ, the final decision of the court meets the expectations of the council at the time, which was to serve the population that needed it and relieve the Judiciary, since the insured person without the benefit filed a lawsuit against the INSS .

“What the TCU’s decision did was to perpetuate an important solution found at the time of the pandemic, which is exactly the use of technology to collaborate with the INSS, medical expertise and, consequently, with the Judiciary”, he says.

Bruno Dantas, president of the TCU, says that the court fulfilled its role. “The TCU fulfilled its supervisory role by confirming that there was a legal violation in the refusal of remote inspections during the pandemic period. We hope that this decision will contribute to speeding up inspection processes even more from now on, especially for BPC beneficiaries, who need our special attention,” he says.

Medical experts resist teleexpertise

INSS medical experts resist the implementation of teleexpertise and, in a statement on their social networks on May 10, said they were breaking with the Ministry of Social Security. Among the experts’ complaints are the lack of dialogue and the lack of appointment of a director for the area in the portfolio.

For Francisco Eduardo Cardoso, vice president of the ANMP (National Association of Expert Doctors), the INSS was not silent regarding the implementation of teleexpertise in the pandemic, what happened was a lack of impracticability. “The autarchy tried to do this and, due to the total ethical and technological unfeasibility, it was not — and never will be — possible to carry out the measure.”

Cardoso says that the CFM has “constitutional and legal competence” to discipline the activity of doctors and, in this case, prohibit teleexpertise. “It is absolutely inconceivable that the Judiciary issues any decision in the sense of forcing the compulsory and arbitrary implementation of the teleexpertise”, he says.

In a note, the CFM states that it did not have access to the TCU’s decision and says that it is not against teleexpertise. “Since 2022, a resolution – nº 2.325/2022 – has been in force that defines and disciplines the use of communication technologies in the medical expert evaluation. In the text, all the criteria that must be observed for this activity to be carried out are described with legal security and in an ethical way”, he says.

The council also states that it is up to the competent body to implement the measure, provided that it follows the recommendations of the CFM and knows that “the responsibility of the medical expert act is linked to professional autonomy, with respect to the law and the social rights of the beneficiaries”.