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The Decision of the 2nd Panel of TRF5 Confirmed the Fine Imposed by ANS for the Decredentialing of 83 Hospital Entities Without Prior Authorization. The Updated Amount Reaches R$ 25,281,437.62.
The Federal Court upheld the fine imposed on Hapvida by the National Supplementary Health Agency (ANS) for decredentialing part of its hospital network without authorization from the regulator. The 2nd Panel of the Federal Regional Court of the 5th Region (TRF5) unanimously rejected the operator’s appeal and confirmed the validity of the notice of infraction. The AGU acted in the case and reported that there are still pending appeals that have not been finalized.
The penalty arose from an inspection under the Olho Vivo Program, specified in RN 223/2010, which structured proactive audits within large operators. The original fine of R$ 9,338,592.50 (2015) was updated to R$ 25,281,437.62. The case involves decredentialing 83 hospital entities without prior consent from ANS, deemed irregular.
According to the AGU, the Collegiate Board of ANS denied the administrative appeal by the company in 2016. In 2019, the Union filed a tax enforcement action. In 2021, the 33rd Federal Court in Ceará recognized the validity of the notice. TRF5 now upheld the first-instance decision and validated the fine’s dosimetry.
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The AGU stated that the result “ensures ANS’s regulatory power” and the protection of consumers of health plans. The agency emphasized that ANS’s technical area examined the defenses and applied the penalty after thorough investigation of the facts.
Understand the TRF5 Decision on Hapvida and Its Impact on Supplementary Health
The collegiate of the 2nd Panel analyzed Hapvida’s appeal and denied the appeal. Thus, the notice of infraction and the fine remained valid. The court recognized the legality of the administrative decisions that supported the punishment.
In practice, the decision reaffirms that changes in the healthcare network require regulatory control. Decredentialing without authorization can affect beneficiary access and create local supply imbalances.
For the consumer, the message is one of predictability: significant changes in the network must be communicated and evaluated by ANS to maintain continuity of care. The case is gaining relevance in the context of the growth of plans and pressure on hospital networks.
The decision comes at a time of greater judicial scrutiny regarding sanctions against operators. In August 2025, TRF5 also validated the collection of R$ 1.7 million in fines from ANS against Hapvida for coverage denials in 2016-2017.
What Is the Olho Vivo Program and Why Does It Matter
Created by RN 223/2010, the Olho Vivo structured ANS’s proactive, systematic, and planned inspection, focusing on economic-financial and assistance indicators. The goal is to force increasing compliance of operators with regulation and reduce risks to users.
The proactive inspection allows the agency to act before network collapses, verifying care quality, solvency, and complaint rates. It was within this scope that ANS identified the irregular decredentialing that led to the fine.
Although RN 223/2010 was replaced in the inspection arrangement years later, its architecture consolidated the use of data to guide sanctions and course corrections. TRF5’s decision validates the methodology applied in the Hapvida case.
For experts, the continuity of supervisory intervention programs preserves fair competition and patient safety, reducing surprises for beneficiaries when hospitals leave the network without coordination.
Do you think the fine of R$ 25.2 million is proportional to the impact of the decredentialing, or should ANS prioritize adaptation agreements before punishing? Comment if you see the decision as consumer protection or regulatory excess.
A multa de R$ 25,2 milhões da ANS é um excesso regulatório. Embora a agência alegue proteção ao consumidor, essa punição ignora o problema real: a exploração por parte da rede hospitalar privada. Muitos planos de saúde começam com uma vasta rede, mas são forçados a descredenciar hospitais devido aos custos insustentáveis que eles cobram.
Em vez de penalizar os planos, a ANS deveria incentivar acordos de adaptação ou a expansão de redes próprias, que garantem um melhor custo-benefício e mais estabilidade para o cliente. A decisão da ANS é uma solução de curto prazo que não resolve a raiz do problema, servindo mais como um entrave do que como uma proteção efetiva.
Realmente. É bem complicado essa questao . Tem muitk a ser analisado nesse desfecho . Pois a embargos dos dois lados . De um lado o consumidor que e prejudicado qd ha esses descredenciamentos constantes sem a prévia ciência do beneficiário. Imagina q se faça um plano de saude pautado em escolhas e necessidades do usuário, e de repente , se ver aquele credenciamento simplesmente sumir , ficando muitas vezs a pessoa a ver navios e perambular por um atendimento de qualidade. Por outro lado , tem a responsabilidade das operadoras em manter o custo com credenciamento que as vezs se torna abusivo para com as operadoras. Fora as fraudes por parte de clientes e instituições credenciadas. E ainda se some a isso as constantes atualizações de servicos médicos que as operadoras sao obrigadas a acompanhar , e multas . Entao , termina que tudo isso sai do bolso de quem no final desse processo? Do consumidor, claro . Mensalidades altíssimas com reajustes anuais que inviabilizam a continuidade no plano de saude . Deve haver uma atencao aos detalhes para equilíbrar o processo .