A recent investigation at the Pedro Andrade Institute, in São Paulo, revealed evidence of fraud in a scheme that caused losses of more than R$2 million to the insurance company SulAmérica.
Suspicions have recently emerged regarding possible medical reimbursement fraud carried out by the Institute founded by Pedro Andrade, the singer’s new boyfriendSandy. According to information from the Leo Dias portal, the insurance company About America found inconsistencies in the reimbursement requests, which raised doubts about the legitimacy of the documents presented.
At the heart of the controversy is a strategy to maximize reimbursements, in which bills were issued that did not match the true value of medical care. A specific case concerned a medical visit estimated for R$ 3,500.00, but documented through an invoice worth only R$ 1,200.00.
How does the refund procedure work?
Reimbursement in supplemental health plans allows beneficiaries to obtain reimbursement for the costs of directly paid medical services. To this end, it is essential that the documentation provided to the insurer corresponds exactly to the service provided. Any discrepancy between the amounts received and charged is, of course, cause for further investigation.
In the case in question, SulAmerica found duplicate receipts sent in the name of the same beneficiaries, as well as amounts deemed atypical with respect to the services provided. These irregularities raised a warning signal for what could be a complex fraud scheme.
Refund requests reached R$2 million
According to SulAmerica, more than 6,600 refund requests have been made…
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Source: Terra
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