New inspection regime for INSS certificates worries Brazilians; understand!

The INSS innovated and is now investing in a new inspection regime. See how this can affect policyholders!

A new era begins at the National Social Security Institute (INSS) with the implementation of an advanced artificial intelligence system for evaluating medical certificates related to sickness benefit.

This change, which will begin from now on, represents a significant milestone in the way the INSS processes and monitors sickness benefit requests, ensuring greater efficiency and transparency in the system. In this article, we will explore how this technology works and what it means for INSS beneficiaries.

The INSS started using a new system to analyze certificates for aid. Understand what this changes! / Credit: @jeanedeoliveirafotografia / pronatec.pro.br

The new artificial intelligence (AI) tool developed by the National Social Security Institute (INSS) and Dataprev, aims to identify possible fraud attempts on medical certificates and other documents related to sickness benefit.

This technological innovation, which is currently in the testing phase, promises to revolutionize the process of verifying and approving temporary disability benefits. To give you an idea, in 2023, more than 1.6 million complaints were made via AtestMed, but around 46% were refused for not complying with the rules.

How does AI work?

Let’s detail how this tool works:

Cross-referencing of registration data: the tool compares the doctors’ registration data with those that appear on the certificates. This includes checking the registration number with the Regional Council of Medicine (CRM), specialty, place of work, and even the IP of the computer used to send the certificate; Identification of inconsistencies: AI is capable of identifying any inconsistencies in information, such as differences in the CRM number, irregularities in signatures and variations in the content of the certificate; Systematic and rapid verification: unlike manual verifications, the AI ​​tool can perform systematic and rapid analyses, identifying patterns and irregularities with greater efficiency; Analysis of registered documents : AI analyzes documents sent through AtestMed, a system that replaces traditional medical expertise, allowing INSS beneficiaries the possibility of sending their medical certificates digitally.

Consequences of falsifying certificates

Forgery or use of false certificates can result in severe penalties, including a sentence of up to five years in prison. Furthermore, sick pay beneficiaries who acquire fraudulent certificates may be dismissed for just cause and will have to reimburse the amounts received.

New rules for INSS certificates

Medical certificates must now meet specific requirements to be accepted:

Issuance by doctors with registration in the CRM without erasures;Clear specification of the necessary time off;Diagnosis (when authorized by the patient);Legable identification of the issuer, with signature and stamp or registration number in the CRM;Inclusion of the International Classification of Diseases number (CID) corresponding.

Identification of false certificates

According to the INSS, a medical certificate can be considered false if it is drawn up by an unqualified person, if the content is not true, or if it is proven that the document has been tampered with.

Who is entitled to sickness benefit?

Sickness benefit is a benefit granted by the National Social Security Institute (INSS) for workers who, due to illness or accident, are temporarily unable to carry out their work activities.

To be eligible, the insured must have medical proof of their disability, in addition to completing a minimum period of contribution to the INSS, except in cases of work accidents or specific illnesses listed by Social Security.

This benefit is essential to guarantee the financial security of workers during the period in which they are away, ensuring their livelihood until they can resume their professional duties.

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