Fox in the henhouse: ANS rushes to authorize Rede D'or to buy SulAmerica and maintain illegal concentration of health services.

247, by Joaquim de Carvalho - In the final days of the Bolsonaro government, the National Health Agency (ANS) scheduled for this Monday (December 12th), in an extraordinary and "restricted" (secret) session, the vote on the largest transaction in the history of the supplementary (private) health market: the acquisition of SulAmérica, one of the largest health plan operators in Brazil, by Rede D'or, the largest Brazilian hospital company, which, in turn, already owns 29% of Qualicorp, also the largest benefits administrator in the market. This total vertical integration is expressly vetoed by the ANS and has just been questioned by Senator Randolfe Rodrigues in an official letter sent to the ANS, without a response so far. The reason given for the lack of response is that the process is secret.

The matter is also seen as surprising and suspicious by Arthur Chioro and Humberto Costa, former health ministers and members of the health sector in the transitional government. They are outraged by the unusual speed given to such a complex and large process, at the end of a government defeated at the polls. 

The central problem is that there is a regulatory resolution from the ANS (National Agency for Supplementary Health) from 2009, fully amended in 2022, which expressly prohibits a benefits administrator, in this case Qualicorp, from being part of the same economic group as a health operator, in this case SulAmérica, due to conflict of interest reasons and not due to market percentage concentration. 

the votes

The process was expedited even in the face of two negative technical opinions on the transaction from the Directorate of Standards and Operator Licensing (Diope), headed by Jorge Antonio Aquino Lopes. This is the competent technical directorate for this matter. In their opinion, the technicians state:

(…) with apologies for the informality, which is adopted for the sake of clarity: even if the fox declares itself a vegetarian, it cannot be accepted that a fox should be in charge of the henhouse.

The president of ANS, Paulo Rebello, former chief of staff to Ricardo Barros at the Ministry of Health and directly linked to the PP (Progressive Party), involved in controversies such as the Prevent Senior case in the Covid CPI and for having illegally accumulated superpowers at ANS due to interim directors with expired mandates, anticipated the discussions and cast his vote in favor of the transaction without any restriction, immediately followed, at the same meeting on September 30, by Maurício Nunes da Silva, from the sectoral development directorate (Dides), Rebello's political protégé. 

Director Eliane Medeiros, a political protégé of Senator Alexandre Silveira (PSD-MG), from the Directorate of Standards and the Directorate of Product Qualification (Difis), and a retired public defender from the State of MG, has not yet commented.

Behind the scenes, it is considered certain that he will accompany President Rebello in his endeavor, noting, however, that there should be no controlling stake held by Rede D'or in Qualicorp. There is no legal provision for such an arrangement.

In 2000, Eliane was involved in scandals during the Parliamentary Commission of Inquiry into drug trafficking at the Minas Gerais Legislative Assembly and was even removed from her position as director of rehabilitation at the Ipaba Penitentiary. She was cited in a complaint filed with the Commission alleging she was part of a scheme to facilitate escapes.

The CPI report explicitly mentions her:

The Commission also found that Eliane (then Director of Re-education at the Dênio Moreira de Carvalho Penitentiary), behaving in a completely illegal manner, took prisoners to perform masonry work at her residence. There are suspicions of the involvement of authorities in an episode in which one prisoner impersonated another and forged the latter's signature on a summons sent by the Federal Police. (...) The CPI found that Eliane Medeiros and Tarcísio Ângelo, Director of Security at the same facility, were facilitating the granting of various benefits to prisoners, especially drug traffickers, without meeting the requirements and prerequisites of the Penal Execution Law.”

Behind the scenes, it is considered certain that Eliane will accompany the president of the ANS (National Agency for Supplementary Health) in his endeavor in favor of Rede D'or, noting, however, that there should be no controlling stake held by Rede D'or over Qualicorp. There is no such legal provision in the ANS. 

Alexandre Fioranelli, from the Directorate of Product Standards and Licensing (Dipro), a vascular surgeon affiliated with Santa Casa de São Paulo, although he has previously provided services to Rede D'or itself, is expected to support Diope and veto the negotiation, questioning the allegedly illegal procedural steps adopted by Rebello. Diope and Dipro are the technical areas of the organization and are against the transaction in its current form, which they consider illegal. 

The most curious thing is that Rebello decided to exclude Jorge Aquino's vote from the (secret) meeting that will take place this Monday, alleging that he was the original plaintiff. Considering that there are no longer five but four voters, in case of a tie, the deciding vote will be cast by the president himself. The game is rigged, with marked cards.

In the market, some are already calling this vote "RNRD – Rede D'or Normative Resolution," even though it wasn't a RN, nor did it comply with all the internal regulations inherent to issuing a new resolution. It is known that within the ANS (National Agency for Supplementary Health), there are serious controversies surrounding the issue, pointing to irregularities that seem to have been hastily disregarded by the president. 

Rede D'or is already certain that its request will be approved by the ANS (National Agency for Supplementary Health). With this, it will become the largest health company in South America, even larger in revenue than the SUS (Brazilian Public Health System), having vertical control over the entire economic chain of supplementary health.

The case is so scandalous that it deserves a Parliamentary Commission of Inquiry or a thorough investigation, not with the vices of Lava Jato, but impartial. Following the technical opinion of Diope, a regulatory and user protection body for health plans, the ANS cannot help the fox into the henhouse, even if it swears it has become vegan.

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I contacted the ANS (National Supplementary Health Agency) and requested an interview with President Rebello. The Agency's response follows:

The National Supplementary Health Agency (ANS) clarifies that the merger request between Rede D'Or and the SulAmérica operator is under a confidential process, due to legal requirements. For this reason, interviews on the subject cannot be granted, nor can clarifications be provided regarding the matter published by Brasil 247 today (November 29, 2022).

Similarly, the closed meetings of the board of directors and their deliberations also remain confidential, so it is important to emphasize that the disclosure of confidential matters may result in liability for whoever publicizes and reproduces the content of the deliberation.

However, in order to maintain a connection with reality, it is important to emphasize that the positions of the directorates, as well as the decisions of the ANS's collegiate board, are based on opinions from their technical areas, and it is normal to have different and divergent positions. Therefore, it is not accurate to claim that the CEO of the ANS "overrides technical opinions."

ANS always values ​​open and unrestricted dialogue on matters within its competence through all communication channels, but it is necessary to emphasize the sensitive nature of the subject matter.

The following is the official letter from Senator Randolfe Rodrigues (Rede-AP), which also went unanswered: