SUS screening drops 89%, health workers link fraud with death

Over the past eight years, the audit and inspection procedures carried out by the National Audit Department of the Unified Health System (Dynasus) have decreased by 89%. The fall occurred throughout the national territory, and according to specialists and officials consulted by the Ministry of Foreign Affairs CNN, this scenario makes it possible to no longer detect and deal with irregularities, which, in the latter case, can have a direct impact on the lives of users A health system (SUS).

For two months, the heart of the investigation CNN Analyze audit reports and Ombudsman documents, as well as consult with physicians and persons associated with the inspection area as part of the SUS. Reports indicate that the decline of control is also accompanied by political persecution and directives for unrealistic reports, thus covering up wrongdoing.

For the former auditor of Anasus and now president of the Consortium of employees of the national system of auditing of the unified health system (Unasus-Sindical), Solimar Mendes, the resources should be better used and inspected, because “the frauds in matters health causes death ”.

To understand data from Denasus’ audit and inspection procedures, see the Report on Denasus Ministry of Health which show that the decrease in interventions has been systematically occurring since 2018. In that year, 579 interventions were carried out, ie 57% less than 1,356 in 2017; The pattern continued for years to come.

For health management consultant Eriko Vasconcelos, the lack of inspection and poor transport standards give way to suspicious transactions. “During my tenure at the Ministry of Health, a very small group of workers could have been observed responding to complaints and other inquiries regarding the need for inspection or auditor intervention. “

dynamo performance

According to SUS’s annual management reports for which the article was available, only the Denasus audits between 2011 and 2013 resulted in return requests of R $ 650 million. As of 2014, reports have ceased to report claim amounts.

In one of the documents, a return request is made, following an audit by Denasus, which revealed, in 2016, that the Result Medicina Diagnóstica did not provide proof of the tests carried out for SUS in the city ​​of São Gonçalo (Royal Jordanian). While visiting the lab, the auditors discovered that the company was operating with outdated equipment and not following best practices. As a result, R $ 1.8 million for examinations paid by Health to the company between 2009 and 2016 had to be returned.

In a document, the Ministry of Health of Rio de Janeiro demands the return of R $ 1.8 million to the Municipal Health Fund of Sao Gonçalo / Reproduction

Another Denasus survey, released in February this year, looked at contracts the state’s health department had signed with air taxi companies and recommended that Rio Branco Aerotaxi reimburse more than R $ 1 million. . The company was hired between 2016 and 2019 to transport patients for treatment away from home. The documentation indicates that these values ​​were not compatible with the services provided.

Audit indicates differences in Acre / Reproduction health contracts

Currently, according to data from Unasus-Sindical, the state of Acre has only three employees engaged in the audit. This number, according to the entity, is not enough to constitute a team, “let alone to audit a complete file,” said Solemar.

There are hundreds of reports analyzed by the report which refer to other issues. Among the documents are cases of shortages of doctors, hospitals operating without health permits, gas leaks, expired fire extinguishers, and cases of hospital shutdowns. Receive resources from SUS. In many of these cases, the reports were accepted by the hospital administrators involved, who pledged to resolve the issues.

Document revealing infrastructure problems in hospital units
Document revealing infrastructure problems in hospital / reproductive units

Lack of professionals and interference

The decline in Dynasus’ stock can be attributed, in part, to the organization’s low membership and political interference from the allies. Ricardo barros At the agency, when he was health minister, a former auditor said in the report on condition of anonymity. According to this former employee, the number of auditors has been reduced for nearly a decade due to the retirements of professionals and the lack of replacement.

It also reveals that there is great dissatisfaction from officials who do not consider themselves appreciated and that there is interference from the Director General of Brasilia in the preparation of the final reports.

There are no doctors in the supervisory body. If you need to audit any area of ​​healthcare, Solemar says, the national audit service doesn’t have that server on board.

According to the source, several initial reports he submitted that indicated irregularities to directors of municipalities, states or health units were referred for review after performing an analysis of Dynasos headquarters in Brasilia. He says these revisions were, too often, guidelines to omit irregularities from the final text.

He says the worst period was between 2014 and 2019, when the decline in enrollment was more severe and the intervention became more present, especially during the period from 2016 to 2018, under the administration of Ricardo Barros.

At the time, Barros would put people he trusted in charge of the state’s Dynasos units and control what was reported. The former auditor recounted that some of the reports containing the accusations were returned to the auditors for editing or edited directly by superiors.

Solímar Méndez also said he was the victim of political interference while working as an auditor and cited a case involving the former president of Dinasos de Mato Grosso, Joao Paulo Martins Viana, who was removed from his post as director of the agency after an audit that highlighted the misuse of health funds in Cuiaba. “We believe that his dismissal had political interference (…) It was clear that there had been political interference,” he explains.

The report spoke with Viana, who confirmed his firing as the director of Dynasos, but he declined to be interviewed as he is still a federal government employee and is not allowed to speak.

Double empty reports

Former Denasus director Louis Bolzan also believes that only retirements and fewer employees do not explain such a large drop in audits. According to him, some managers do not give their due status to the work of auditors and act in a way that weakens the institution.

“To weaken Dynasus means to weaken the control and anti-corruption measures in the public health of this country. It is very important to strengthen and restore audit procedures because Dynasos and the national audit system are very important tools for the organization of the unified health system, the qualification of the SUS administration and the qualification of the service. returned to the public health citizen in this country, ”says Bolzan.

a CNN It examined the 954 audit reports available on the portal of the national audit system SUS produced between 2016 and 2017 and found that 53 of them were blank and consisted of only one page, as shown in the picture below.

Blank / cloned audit reports

During the same referenced reporting period, there was also a weakness in one of the few methods that healthcare uses to monitor the relationship between procedures performed and those advertised.

Luis Bolzan explains: “The SUS message was a message sent to the homes of Brazilian citizens, users of the health system who, for example, were hospitalized by the unified health system. A citizen of a certain era.

a CNN Ask health care about the condition. The ministry responded in a note: The Ministry of Health informs that there is no post for a Unified Health System (SUS) auditor within the ministry, and therefore the opening of a specific competition for the region depends on the decision of the ministry and the ministry. Authorization from the Ministry of the Economy. It should be noted that the National Audit Department of SUS (Denasus) conducted internal selection processes, with the aim of selecting the staff of the Ministry of Health to work in the implementation activity and support technique for the review of procedures and health services and the implementation of public policies within the framework of the SUS, in the central unit, in Brasilia and in 26 audit departments, One department in each state of the union. Note that in 2020, the procedure made it possible to select 15 employees for the Brasilia central unit, and in 2021, 32 new employees were selected for the Rio de Janeiro unit. Internal selection is still ongoing for units located in the North region, with approximately 63 new servers. As for the units in the South and South-East regions, with 55 servers that should be selected.

In a statement, MP and former Minister Ricardo Barros said that the closure of the SUS charter happened because it had a very high cost and was inefficient, since, according to him, it only serves 2% of the population and has no insignificant return. . The model, according to Barros, has been replaced by telephone service.

However, Bolzan claims that refunds with just a few cards back will be enough to pay for the service. “He was interrupted. It is no longer in use between 2016 and 2017, unfortunately what was heard was the budget argument, saying it was too expensive, when in fact it was a one-time measure that we could implement to reduce corruption and misappropriation of resources in the SUS. It will make him profitable, ”he says.

a CNN He has researched the others mentioned and is waiting for a response.

* Under the direction of José Brito

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