Reduction of medical fees contravenes the Code of Medical Ethics

The Brazilian College of Radiology and Diagnostic Imaging (CBR) has received warnings from some associates regarding some health care providers, which have practiced decreasing the values of certain procedures or even reducing the total amount billed.

Code changes or glosses from previously authorized procedures have also occurred. The reduction happens not only to documentation and the Operating Cost Unit (UCO), but also to medical fees.

The Code of Medical Ethics establishes principles of good medical practice relating to working and care conditions, professional autonomy, freedom of choice of the physician by the patient, unrestricted availability of means of diagnosis and treatment and the dignity of professional remuneration.

Chapter I of the Code of Medical Ethics (Resolution CFM 1931/2011) reports such principles in the following paragraphs:

1) Paragraph VIII - The doctor may not, under any circumstances or under any pretext, waive his professional freedom, nor allow any restrictions or impositions that may impair the efficiency and correctness of his work.

2) Paragraph X - The work of the physician may not be exploited by third parties for profit, political or religious purposes.

Article 19 of the same Code provides the following information: Failure to ensure, when invested in a position or function of direction, the rights of physicians and other appropriate conditions for the ethical and professional performance of medicine.

Resolution 1642/2002, for its part, brings in its caput:

Companies acting in the form of direct provision or intermediation of medical services must be registered with the Regional Medical Councils of their respective jurisdiction, as well as respect the professional autonomy of doctors, making payments directly to them and without subjecting them to any restrictions; In contracts, the current form of readjustment must be explicitly stated, submitting their tables to the CRM of the state where they operate. Medical confidentiality must be respected and no disclosure or diagnosis required.

Article 1 - Health insurance, group medicine, medical work cooperatives, self-management or other companies acting in the form of direct provision or intermediation of medical-hospital services should follow the following principles in their relationship with Doctors and users:

a) respect the autonomy of the physician and the patient regarding the choice of diagnostic and therapeutic methods;

b) admit the adoption of medical guidelines or protocols only when these are prepared by the Brazilian specialty societies, in conjunction with the Brazilian Medical Association;

c) to practice fair and dignified professional remuneration for medical work, submitting the fee schedule for the approval of the CRM of its jurisdiction;

d) make the payment of fees directly to the doctor, without retention of any kind;

e) negotiate with entities representing physicians the annual readjustment of compensation until May, preventing the professional fee from undergoing reduction or depreciation process;

f) prohibit the binding of medical fees to any parameters that restrict the request for complementary exams;

g) respect professional secrecy, being forbidden to these companies establish any requirement that implies the disclosure of diagnoses and facts that the physician has knowledge due to professional practice.

Thus, the CBR understands that the operator represented by its technical director, as well as its doctors in charge of management, may contradict the Code of Medical Ethics by reducing the remuneration of imaging physicians who have previously performed unilaterally authorized examinations without bargaining by restricting the freedom to pursue the profession through levies that can be used to increase the profits of the supplementary health care system and thus exploiting medical work.

Therefore, the image services contracting company, in the person of its medical legal representative and its technical director, in maintaining this position, may be denounced to the Regional Medical Council of the respective jurisdiction.

Remember that the best way will always be dialogue, but unfortunately the imposition and reduction of fees have been a common behavior of many operators.

Radiology associations of the respective region, duly represented by their associates, may mediate such negotiations in the search for a solution.

The CBR is available for whatever is necessary in this regard.


Dr. Cibele Alves de Carvalho
CBR Professional Defense Director


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Written by

Thiago Braga

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