A group led by doctor Patrícia Adi Massat is suspected of defrauding health plans of more than R$2 million, by receiving reimbursements for false consultations and medical exams.
According to investigations by the Civil Police, the gang operated in a commercial space in Campo Grande, in the West Zone of Rio. Patrícia, who is the owner of the space, was also responsible for obtaining the information to carry out scams on health plans .
The scheme also involved other victims, such as fellow doctors and other medical service providers.
According to the police, Patrícia hired these professionals to work at her clinic and, without them knowing, she forged signatures and other items, such as personal stamps.
The group’s idea was to be able to request reimbursements from at least three large health plan operators. One of the victims, who did not want her identity revealed, told RJ2 how she found out about the scam.
“There were almost 50 receipts with my name that I didn’t recognize, that I didn’t issue, with a fake stamp of mine that I never gave authorization to do. I had emails from several places. One that I worked at and two other places that I had never heard of. I didn’t know about these clinics and even procedures that are a little outside my specialty”, revealed the doctor.
The scam worked for almost two years. During this period, the group falsified numerous medical procedures, consultations and therapies, always inserting true data from medical professionals.
With the fake receipt, the gang asked the health plan for reimbursement. The plan evaluated and, if approved, paid reimbursement to the client, who was also linked to the group.
Scammers confess
The million-dollar scam began to be discovered by health plan operators, who became suspicious of the volume of reimbursement requests.
As the investigations progressed, the suspects confessed to the crime and reached an agreement with part of the injured companies, refunding the defrauded amounts. To date, the group has returned over R$2 million.
In their statements, Patrícia and another doctor involved in the scheme, Catiana Contrim, stated that the idea of carrying out the scam came from Rodrigo de Mello Nascimento, during the Covid pandemic.
The three will not be charged with the crime of embezzlement for having reached an agreement and returned the defrauded amounts to the companies. However, investigations continue to determine the ideological falsehood, as they pretended to be other professionals.
Fraud and threats
A common feeling among scam victims is fear of retaliation from the group that carried out the fraud. Some of the professionals whose names were used in the coup agreed to speak, but did not agree to reveal their identities.
The victims say that during the process of investigating the fraud, the accused threatened legal action if they decided to talk about what they suffered.
The suspects’ lawyers informed that the victims could not comment on the matter, not even in message groups, under penalty of being arrested.
“I am the victim and it ended up that I was cornered by her. You feel in a very threatened position, not being able to speak (…) But we are only here to tell the truth”, commented the victim.
Cremerj opens investigation
The Brazilian Association of Health Plans said that this type of investigated fraud is common and asked doctors for attention.
“This forgery of stamps, false services, this is a complex crime. It shows how real gangs are becoming professional. (…) Do not give your stamp to a third party. The medical prescription and all documents are the responsibility of the doctor”, commented Cassio Alves, superintendent of the Brazilian Association of Health Plans.
Doctor Patrícia Adi Massat was reported by the victims to Cremerj, but still continues to work.
“Ethical processes must be opened, these people must be punished quickly. Complaints to the councils must be made and monitored”, added Cassio.
What those mentioned say
None of those suspected of participating in the coup agreed to speak to RJ2. The suspects’ lawyer informed that the investigation remains ongoing and that those involved deny the accusations and will defend themselves.
Cremerj said that it opened an inquiry into the case, that the procedure is ongoing and remains confidential, following the ethical-professional process code.
