By Brazil Stock Guide — Brazil’s antitrust watchdog Cade opened a formal investigation on August 24 into Coopanest-PE, a physician cooperative that brings together nearly 72% of the anesthesiologists in Pernambuco, a northeastern Brazilian state, and Saepe, the state’s anesthesiology professional society.
Cade’s General Superintendence said it found sufficient indications to investigate possible abuse of a dominant market position, attempts to influence anesthesiologists’ commercial conduct and the use of threats to suspend services or terminate accreditation agreements during negotiations with hospitals and health insurers.
The opening of the investigation does not amount to a finding of wrongdoing. Cade said it still needs to determine whether the conduct breached competition law or reflected the legitimate activities of a medical cooperative.
Coopanest has 798 members among Pernambuco’s 1,110 active anesthesiologists, or 71.89% of the total, according to data reviewed by Cade. The watchdog preliminarily found that the cooperative holds a dominant position in the state’s anesthesiology market. Saepe, meanwhile, has 905 members, equivalent to 81.53% of the anesthesiologists registered in the state.
The case predates Rede D’Or’s involvement. Cade received an anonymous complaint in February 2025 alleging that Coopanest imposed price increases above market levels and threatened to stop providing services when its terms were rejected. The watchdog opened a preliminary proceeding the following month.
In December 2025, Rede D’Or and SulAmérica, the health insurer controlled by the hospital group, filed their own complaint and broadened the allegations. They argue that Coopanest uses its concentration of physicians to impose prices and commercial terms while making it harder for rival providers to enter the market.
A study submitted by SulAmérica to Cade estimates that Coopanest’s prices are between 167% and 171% above a benchmark used by the insurer. Compared with São Paulo, Brazil’s largest healthcare market, the average cost of an anesthesiology event in Pernambuco would be 354% higher — about 4.5 times the São Paulo level — according to the company.
Another analysis submitted by Rede D’Or and SulAmérica compared nine anesthesiology cooperatives across Brazil and found that Coopanest’s prices were 48.6% above the group’s weighted average. The figures are allegations made by the complainants and remain subject to review by Cade.
The dispute intensified after Rede D’Or signed a non-exclusive agreement with Fluence Anestesia in November 2025. Fluence had been seeking to expand in Pernambuco, and Rede D’Or said the agreement was intended to provide an alternative source of anesthesiology services and reduce its dependence on a single supplier.
Rede D’Or and SulAmérica allege that, after Fluence was hired, Coopanest and Saepe took steps aimed at hindering the rival’s operations, including sending formal notices, filing complaints with medical bodies, issuing public statements and threatening service suspensions.
Cade’s preliminary inquiry also collected accounts from other market participants. Health insurer Camed Saúde told the watchdog that it had been unable to find alternatives to Coopanest for anesthesiology services in Pernambuco and said it had received threats of service stoppages during commercial negotiations, including by email.
Saúde Caixa, another health insurer, told Cade that Coopanest negotiates on behalf of physicians and that anesthesiologists affiliated with the cooperative are paid under the same terms. The insurer also reported service suspensions in the past, although it said more recent negotiations reviewed by Cade had taken place without threats of suspension or termination.
Coopanest denies the allegations. In documents submitted to Cade, the cooperative said it does not use a single price or standardized fee schedule, that terms are negotiated according to each contract and that physicians are not required to work exclusively through the cooperative.
It also said any interruption of services results from contractual or operational issues rather than an attempt to exert competitive pressure.
Coopanest said it maintains internal antitrust compliance policies and does not punish or restrict members who choose to work outside the cooperative. It also disputes allegations that it prevents hospitals or insurers from challenging or auditing medical bills.
Saepe likewise denies involvement in commercial practices. The professional society said it does not negotiate prices or contracts, require exclusivity or interfere with its members’ professional freedom. It describes its relationship with Coopanest as scientific, professional and representative rather than commercial.
Coopanest has previously been involved in a Cade case concerning abuse of a dominant position and efforts to influence uniform commercial conduct. The cooperative says it has since adopted commitments designed to bring its practices into line with Brazilian competition rules.
Despite opening the investigation, Cade’s General Superintendence rejected, for now, a request from Rede D’Or and SulAmérica for interim measures. The companies had asked the regulator to bar Coopanest from suspending services, pressuring anesthesiologists or campaigning against rival providers while the case is under review.
Cade said the evidence gathered so far is sufficient to justify a full investigation but does not yet demonstrate a “concrete, current and imminent” risk that would warrant emergency intervention. The watchdog said interim measures could still be reconsidered if stronger evidence emerges.
Cade now plans to seek additional information from hospitals, health insurers and other market participants to assess how anesthesiology services are contracted, whether rival providers can recruit physicians in Pernambuco and whether artificial barriers are restricting independent doctors and new entrants from competing in the market.
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