STF (Brazilian Supreme Court) Affirms The Constitutionality Of HMOs' Obligation To Reimburse SUS (Public Health System) For Public Medical Care

Author:Mr Felipe Bastos and Fernanda Tostes Malta De Oliveira
Profession:Veirano e Advogados Associados

Section 32 of the Health Plans Act (Federal Law no. 9,656/98, as amended) establishes that private health plans (commonly known as Health Maintenance Organizations or delivered by the latter to individuals enrolled with HMOs. Since its inception, such duty has raised a heated debate amongst HMOs, hospitals and other medical services providers both for its uniqueness and for creating an obligation for private entities to fund the public health sector, which claims to be universal and entirely free of charge. On a judgement session held yesterday, the STF unanimously (9 Justices voted) held that the reimbursement by HMOs to SUS was fully lawful and in line with the Brazilian Constitution. Justice Marco Aurélio Mello delivered the opinion of the court. He concluded that the healthcare services agreement obliges HMOs to pay for medical care, regardless of whether such care is provided for by private or by the public sector. He added that concluding otherwise would amount to unjust enrichment on the part of the HMOs. Justice Alexandre de Moraes further stated that people only go to the public health system when HMOs fails to fulfill its duty to deliver care.

The lawsuit challenging the constitutionality of the Health Plans Act was brought by the Health National Confederation...

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