Supreme Court Justice Gilmar Mendes warned on Wednesday (30) that lawsuits filed by hospitals seeking higher reimbursement rates from SUS, Brazil's public health system, could add about R$ 24 billion (roughly US$ 4.6 billion) a year to the Health Ministry's budget. In official letters to the president of the Supreme Court (STF), Edson Fachin, and the president of the Superior Court of Justice (STJ), Luis Felipe Salomão, the court's longest-serving justice asked for measures against what he called the "irregular issuance of precatórios by the Judiciary", in some cases before rulings become final, according to Folha de S.Paulo. Precatórios are court-ordered debt certificates that the government must pay after losing a lawsuit definitively.
The dispute involves contracts that private hospitals and philanthropic institutions, such as the Santas Casas, sign to provide complementary services to SUS. These entities have gone to court demanding payment based on the Tunep table, a price reference used by private health insurers, instead of the lower SUS fee table. When they win, the federal government is ordered to pay the difference through precatórios. Gilmar told Fachin he intends to address the issue when ruling on an appeal under his rapporteurship filed by the Santa Casa de Misericórdia de Juiz de Fora hospital, which claims the SUS table is outdated and demands retroactive payments from the federal government.
What is an estimate and what is already confirmed
The R$ 24 billion figure cited by Gilmar is a projection of the annual impact if this interpretation prevails in the courts, not money already spent. What is documented so far is the work of the National Justice Council's internal affairs office: on September 23, it canceled 16 precatórios issued by the TRF-1 regional federal court before final rulings and ordered about R$ 4.7 billion returned to the Treasury. On Monday (28), the office expanded the injunction and canceled 14 more precatórios, totaling roughly R$ 1.87 billion, according to the legal news site Migalhas.
Gilmar also said a significant share of the precatórios issued in this kind of lawsuit no longer belongs to the hospitals themselves. According to the justice, the credits are concentrated in a small number of economic agents and have been used to inflate institutional balance sheets. Without naming Banco Master, the failed bank owned by Daniel Vorcaro, he linked the problem to the investigations into the bank, which, according to G1, put R$ 14.3 billion into buying precatórios and credit rights, mostly tied to the sugar and ethanol sector.
In his letter to Salomão, Gilmar highlighted Theme 1,444 of the STJ's repetitive appeals system, which will decide whether a precatório or an RPV (small-value payment order) can be issued before the enforcement phase of a ruling becomes final. The question was assigned to the court's 1st Section in July and no binding thesis has been set yet, Migalhas reported. In the documents, the justice defended joint action by the Judiciary, the Central Bank, the securities regulator CVM, the Federal Prosecution Service and the Brazilian Bar Association.
"A coordinated response from the institutions is required, one that matches the gravity of the facts that have been revealed."
For SUS patients, nothing changes in the short term: no service has been suspended because of this dispute, and the amounts remain under litigation. The concrete next steps are the STJ's ruling on Theme 1,444 and the Supreme Court's examination of the Juiz de Fora hospital appeal. Those two decisions should indicate whether the SUS fee table can be revised through the courts and under what conditions this type of precatório may be issued from now on.