Post by xyz3000 on Feb 12, 2024 8:26:03 GMT
Unimed Santa Maria (RS) is prohibited from requiring cooperative doctors to work only with the cooperative, preventing them from maintaining contracts with other health plans. The decision is from the 2nd Civil Court of Santa Maria, confirmed by a majority vote by the 5th Civil Chamber of the Court of Justice of Rio Grande do Sul. The Public Prosecutor's Office proposed a Public Civil Action against exclusivity with the argument that the consumer is harmed by the practice. This is because, in the absence of competition, service prices may increase, in addition to preventing the emergence of new health plan administrators or making it impossible for existing ones to continue. In the first instance, the action was upheld.
The cooperative appealed the decision, claiming that the nature of the relationship with the doctor is institutional and not contractual and that the prohibition on the member being accredited with other operators also benefits patients, who do not need to submit to busy schedules. And he noted that the Civil Code prohibits the partner from competing with the company of which he is a part. With an unsuccessful Estonia Email List vote, the rapporteur, judge Ana Maria Nadel Scalzilli, understood that the MP could not file the action, as it was about defending the private interests of other health plans. She also assessed that “there is no accreditation of doctors, all of whom are cooperative members, united around a common objective, which is the end sought by the cooperative”. Judge Umberto Guaspari Sudbrack understood that the Public Ministry was capable of proposing the Public Civil Action.
Furthermore, he considered that the health plans law, in article 18 (Law 9,656 / 998), prohibits the practice adopted in Unimed's statute. “The enforcer cannot, especially in a field of this magnitude, where extremely significant homogeneous individual interests are involved, restrict the scope of a law that is extremely broad.” And he continued: “Allowing, solely based on the legal nature of its constitutive act, that a health service provider can operate privilegedly to the detriment not only of cooperative doctors, but above all of consumers, is something that does not seem to me to have support in the interpretation of the aforementioned law”. Judge José Conrado de Souza Junior followed Judge Sudbrack's vote and upheld the first instance decision.
The cooperative appealed the decision, claiming that the nature of the relationship with the doctor is institutional and not contractual and that the prohibition on the member being accredited with other operators also benefits patients, who do not need to submit to busy schedules. And he noted that the Civil Code prohibits the partner from competing with the company of which he is a part. With an unsuccessful Estonia Email List vote, the rapporteur, judge Ana Maria Nadel Scalzilli, understood that the MP could not file the action, as it was about defending the private interests of other health plans. She also assessed that “there is no accreditation of doctors, all of whom are cooperative members, united around a common objective, which is the end sought by the cooperative”. Judge Umberto Guaspari Sudbrack understood that the Public Ministry was capable of proposing the Public Civil Action.
Furthermore, he considered that the health plans law, in article 18 (Law 9,656 / 998), prohibits the practice adopted in Unimed's statute. “The enforcer cannot, especially in a field of this magnitude, where extremely significant homogeneous individual interests are involved, restrict the scope of a law that is extremely broad.” And he continued: “Allowing, solely based on the legal nature of its constitutive act, that a health service provider can operate privilegedly to the detriment not only of cooperative doctors, but above all of consumers, is something that does not seem to me to have support in the interpretation of the aforementioned law”. Judge José Conrado de Souza Junior followed Judge Sudbrack's vote and upheld the first instance decision.