The action brought by SulAmérica Saúde accuses Instituto Pedro Andrade of violating the plan’s reimbursement system
Court grants emergency relief
The Pedro Andrade Institute LTDA, headed by Dr. Pedro Andrade, is at the center of an allegation of fraud by health plan operator SulAmérica. The legal action, initially publicized by columnist Leo Dias, alleges alleged irregularities in the practice of splitting receipts and invoices for medical care to obtain reimbursements.
What happened?
The indictment highlights that between January 2022 and October of this year, 6,637 requests for reimbursement for services were submitted, for a total of R$ 2,787,447.11. Of this amount, R$2,306,754.53 was reimbursed. The situation has raised suspicions of cost-sharing for consultations, a practice that aims to increase the amount to be received as reimbursement. Additionally, the lawsuit states that some refund requests were accompanied by false proof of payment.
Judge Edna Kyoko Kano, analyzing SulAmérica’s request, granted an emergency measure, underlining that “the elements of conviction brought to the record indicate the practice, by the defendants, of acts that violate the system”. With the decision, the institution is prohibited from issuing or splitting tax documents for services provided to beneficiaries of SulAmérica health plans. In case of non-compliance, the expected sanction is R$ 5,000 per infringement, limited to a ceiling of R$ 200,000.
Total suspension of refunds denied
Despite the decision, SulAmérica’s request to suspend all reimbursement requests was rejected by the Court, which considered that this measure could negatively impact patients not involved in the case. Dr. Pedro Andrade and the institute have already been formally cited, but have so far not commented publicly on the allegations.
The relationship between Pedro Andrade and Sandy
The relationship between Pedro Andrade and singer Sandy became public in July this year, but the couple has not officially admitted their relationship. They haven’t denied it, but so far they haven’t shared any photos together either. Even so, Sandy would have already been seen visiting the doctor in his work environment.
Source: Terra
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