In the past eight years, the audit and inspection procedures carried out by the National Audit Department of the Unified Health System (Dynasus) decreased by 89%. The fall occurred throughout the national territory, and according to specialists and civil servants consulted by the Ministry of Foreign Affairs CNN, this scenario allows to stop detecting and dealing with irregularities, which, in the latter case, can have a direct impact on the lives of users One Health System (SUS).
For two months, the core of the investigation CNN Analyze audit reports and Ombudsman documents, as well as consult physicians and persons associated with the inspection area within the scope of the SUS. Reports indicate that the decline in control is also accompanied by political persecution and directives for unrealistic reports, thus concealing wrongdoing.
For the former Anasus auditor and now president of the Consortium of Employees of the National Audit System for the Unified Health System (Unasus-Sindical), Solimar Mendes, resources should be better used and inspected, because “health frauds lead to deaths”.
To understand the data from Denasus’ audit and inspection procedures, see the report Reports from Ministry of Health which show that the decrease in interventions has been occurring systematically since 2018. That year, 579 procedures were performed, 57% lower than 1,356 in 2017; The pattern continued for years to come.
For health management consultant Eriko Vasconcelos, the lack of inspection and poor transportation standards make space for suspicious operations. “During my tenure at the Ministry of Health, a very small group of workers could have been observed to respond to complaints and other demands regarding the need for inspection or intervention by auditors.”
According to SUS annual management reports for which the article was available, only Denasus audits between 2011 and 2013 resulted in R$650 million return requests. As of 2014, reports have ceased to report reimbursement request amounts.
In one of the documents, a request for return is made, as a result of an audit by Denasus, which found, in 2016, that the Result Medicina Diagnóstica did not provide evidence of the tests performed for SUS in the city of São Gonçalo (Royal Jordanian). Upon visiting the lab, the auditors discovered that the company was operating with obsolete equipment and not following best practices. As a result, R$1.8 million for exams paid by Health to the company between 2009 and 2016 were required to be returned.
Another Denasus survey, published in February of this year, reviewed the contracts that state health department had signed with air taxi companies and recommended that Rio Branco Aerotaxi return more than R$1 million. The company was contracted 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.
Currently, according to data from Unasus-Sindical, the state of Acre has only three employees engaged in auditing. That number, according to the entity, is not enough to put together a team, “let alone audit an entire case,” Solemar said.
There are hundreds of reports analyzed by the report that refer to other issues. Among the documents, there are cases of shortages of doctors, hospitals operating without a health permit, gas leaks, expired fire extinguishers, and cases where hospitals have stopped. Receiving resources from SUS. In many of these cases, the reports were accepted by the hospital administrators involved, who were committed to resolving the problems.
Lack of professionals and interference
The decline in Dynasus shares can be attributed, in part, to the organization’s low staffing and political interference by 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 almost a decade due to the retirement of professionals and no replacement.
It also reveals that there is great dissatisfaction on the part of civil servants who do not consider themselves to be 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 audit body. If you need to audit any area of healthcare, Solemar says, the national audit department doesn’t have that server on board.
According to the source, several initial reports submitted by him that indicated irregularities to directors of municipalities, states or health units were returned for review after conducting an analysis of the Dynasos headquarters in Brasilia. He says that these revisions were, all too often, guidelines for omitting irregularities from the final text.
He says that the worst period was between 2014 and 2019, when the decline in staffing was more severe and intervention became more present, especially during the period from 2016 to 2018, during the administration of Ricardo Barros.
At the time, Barros was going to put people he trusted to head the state’s Dynasos units and control what was reported. The former auditor told the story that some of the reports containing the accusations were returned to the auditors for editing or changed directly by the superiors.
Solímar Méndez also said that he was subjected to political interference while working as an auditor and invoked a case involving the former president of Dinasos de Mato Grosso, Joao Paulo Martins Viana, who was removed from the position of director of the agency after an audit that pointed to the misuse of health funds in Cuiaba. “We believe his dismissal had political interference (…) It was clear that there was political interference,” he explains.
The report spoke with Viana, who confirmed his dismissal as Dynasos’ director, but he did not want to be interviewed, because he is still a federal government employee and does not have permission to speak.
Double empty reports
Denasus’ former director, Louis Bolzan, also believes that only retirements and fewer employees don’t explain such a huge drop in audits. According to him, some managers do not give due status to the work of auditors and act in a way that weakens the institution.
“Weakening Dynasus means weakening the measures to control and combat corruption in the public health of that country. It is very important to strengthen and restore the 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 provided to the citizen in public health in that country,” Bolzan says.
a CNN It reviewed all 954 audit reports available on the SUS National Audit System portal produced between 2016 and 2017 and found that 53 of them were blank and had only one page, as shown in the image below.
In the same period of referenced reports, there was also weakness in one of the few methods that health uses to oversee the relationship between procedures performed and those that were announced.
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 period.”
a CNN Ask health about the condition. The Ministry responded in a note: The Ministry of Health informs that there is no position 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 Economy. It is noteworthy that the National Audit Department of the SUS (Denasus) carried out internal selection processes, with the aim of selecting personnel in the Ministry of Health to work in the implementation activity and technical support for the review of health procedures and services and the implementation of public policies within the scope of SUS, in the central unit, in Brasilia and in 26 audit departments, One department in each state of the union. It should be noted that in 2020, the procedure made it possible to select 15 employees for the central unit in Brasilia, and in 2021, 32 new employees were selected for the unit in Rio de Janeiro. Internal selection is still underway for units located in the northern region, with an estimated 63 new servers. As for units in the South and Southeast regions, with 55 servers expected to be selected.
In a statement, Deputy and former Minister Ricardo Barros stated that the closure of the SUS charter occurred because it had a very high cost and was ineffective, since, according to him, it serves only 2% of the population and has no insignificant return. . The model, according to Barros, was replaced by telephone service.
However, Bolzan claims that refunds with just a few cards back will be enough to pay for the service. “It has been discontinued. It is no longer in use between 2016 and 2017, unfortunately what was heard was the budget argument, saying that it was too expensive, when, in fact, it was a single measure for us to be able to implement to reduce corruption and diversion of resources in the SUS It will make it pay for itself,” he says.
a CNN He’s searched for the others mentioned and is waiting for an answer.
* Under the direction of Jose Brito
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