A doctor-led group is suspected of defrauding health plans of more than R$2 million | Rio de Janeiro

A group led by Dr. Patricia Adi Masat is suspected of defrauding health plans in more than… 2 million Brazilian realsBy obtaining compensation for false medical consultations and examinations.

According to civil police investigations, the gang was operating in a commercial space in Campo Grande, in the western region of Rio, and Patricia, the owner of the space, was also responsible for obtaining information to carry out fraud on health plans. .

The scheme also included other victims, such as fellow doctors and other medical providers.

According to the police, Patricia hired these professionals to work in her clinic and, Without their knowledge, She forged signatures and other items such as personal seals.

The group’s idea was to be able to seek reimbursements from at least three major health plan operators. One of the victims, who did not wish to reveal his identity, told… RJ2 How did you know about the coup?

“There were approximately 50 receipts in my name that I did not recognize, nor issued, with a fake stamp of my own that I never gave permission to do so. There were emails from several places. One of these receipts I worked at and two other places I had not heard of from before. I did not know about these clinics and even the procedures are a little outside my specialty,” the doctor revealed.

The scam operated for about two years. During this period, the organization falsified many medical procedures, consultations, and treatments. Always enter real data from medical professionals.

Using the fake receipt, the gang asked the health plan to reimburse the costs. The plan was evaluated and, if approved, reimbursement was made to the client, who was also associated with the group.

The discovery of a $1 million fraud was initiated by health plan operators, who questioned the volume of reimbursement requests.

As the investigation progressed, The defendants confessed to committing the crime and reached an agreement with part of the affected companiesand recovering stolen amounts. To date, the group has returned more than R$2 million.

Patricia and another doctor involved in the scheme, Catiana Contrim, stated in their statements that the idea of ​​carrying out the scam came from Rodrigo de Mello Nascimento, during the Covid pandemic.

All three He will not be charged with the crime of embezzlement For their agreement to return the fraudulent amounts to the companies. However, investigations are still ongoing to determine their ideological falsity, as they pretended to be other professionals.

A common feeling among fraud victims is fear of retaliation from the group that carried out the fraud. Some professionals whose names were used in the coup agreed to speak, but did not agree to reveal their identities.

Victims say that during the fraud investigation process, the defendants were threatened with legal action if they decided to talk about what they had been exposed to.

The suspects’ lawyers reported that the victims were unable to comment on the matter, not even in group messages, under penalty of arrest.

He commented, “I am the victim and it ended up being trapped. You feel like you are in a very threatened situation, so you can’t speak (…) but we are just here to tell the truth.” victim.

Kremerge opens an investigation

The Brazilian Association of Health Plans said the type of fraud investigated was common and asked doctors to pay attention.

“This counterfeiting of stamps and false services is a complex crime. It shows how real gangs have become more professional. (…) Do not give your stamp to a third party. The prescription and all documents are the responsibility of the ‘doctor’,” commented Cassio Alves, supervisor of the Brazilian Association of Health Plans. .

Dr. Patricia Adi Masat was reported by victims to Kremerge, but is still working.

“Ethics processes must be opened, and these people must be punished quickly. Complaints must be submitted to councils and monitored,” Cascio added.

None of the people suspected of participating in the coup agreed to speak to RJ2. The defendants’ lawyer explained that the investigation is still ongoing and that those involved deny the charges against them and will defend themselves.

Kremerge said that she has opened an investigation into the case, and that the procedure is ongoing and remains confidential, in accordance with the rules of the professional ethical process.