ANS shall pay a fine of U.S. $ 10,000 per day if disobeying the order to review score health plans . TRF2 reaffirms earlier decision

" ANS shall pay a fine of U.S. $ 10,000 per day if disobeying the order to review score health plans . TRF2 reaffirms earlier decision .

Published by the Federal Regional Court of the 2nd Region ( extracted by JusBrasil ) - 1 day ago

        The federal judge Aluisio Mendes reaffirmed earlier decision after presentation of petition by the Federation of National Health Insurance ( Fenasaúde ) , claiming that the NSA has not fulfilled its judicial determination . The magistrate ordered that they be excluded from the calculation of the assessment complaints answered by health plan operators and forwarded to conduct due diligence : " In this context , incumbent noted that the decision was clear in the sense that in situations where a carrier plan health response features , but the regulator considers necessary to carry out investigations to ascertain the presence or absence of undue negative coverage it does not seem reasonable that , even without a finding of fault , ie , without any judgment , even provisional , about the responsibility of the operator of a health plan, there is computing negatives in the evaluation of the security service , especially because , in the records of the administrative proceedings to be instituted , steps will still be made ​​, guaranteed contradictory and full defense , "said Aluisio Mendes , in today's decision .
        The federal judge also ruled that any breach of the order of recalculation of warranty evaluation service generates daily fine of R $ 10 thousand for the ANS .
        The advocate of the cause still recalled that the decision rendered by TRF3 ( São Paulo ) , on appeal from the Brazilian Association of Medical Group ( Abramge ) , a federal judge federal Marli Ferreira adopted as foundations , the same terms of the order made by the Court Federal headquartered in Rio

clarification

        The issue decided by the Federal Court of Appeal based in Rio de Janeiro , on interlocutory appeal , dealing with the rules for the application of points in evaluating the regulatory agency makes health plans .
        As the understanding of TRF2 , a negative score can be imposed in cases where the user complaints were deemed founded and those in which the companies did not provide information .
        However , the negatives can not be granted in cases where operators submit response as well as those in which the complaint has been dismissed : " The situation in which the operator of a health plan provides no answer, in which case , as already noted , there is no impediment for the complaint to be recorded for monitoring warranty service , can not be compared to the situation where the response was mainly because there is rule which provides the documents that are needed to instruct the operator's response health plan , so that it is the regulatory agency , if it considers the inadequacy of the documentation provided , indicate specifically the documents to be submitted by the operator of a health plan, which must be compatible , at this moment , the paucity of time, having in order that the judgment exauriente occur only in the administrative process , " pondered Aluisio Mendes in his decision .

Proc. 2013.02.01.011510-0 "
Access: 05.09.2013