the first evaluations reveal astronomical figures

It was long awaited, today it’s done. Health Insurance has just presented to the Senate the first conclusions of its work undertaken in the context of the fight against fraud. The least we can say is that the sum is incredible. Don’t worry, Objeko’s editorial staff will tell you everything about it. Are you ready ?

Fraud is a big number

How much does social security fraud represent? This is the question that the Court of Auditors has been asking itself for a long time. Well, today we have answers. Indeed, since the end of 2020, Health Insurance has undertaken a vast investigation to try to quantify the amount of fraud of which it is the victim. And this Wednesday, May 11 in the Senate, the first conclusions were presented. As you can imagine, the figure amounts to several tens of millions of euros.

First, the Health Insurance took the example of liberal nurses. By analyzing their 2018 billing data, the result is clear. The fraud is notably estimated between 286 million euros and 393 million euros. For information, during that year, social security reimbursed no less than 5.7 billion. Fraud is essentially linked to non-compliance with the invoicing nomenclature as well as fictitious or multiple invoicing.

How to deal with this fraud?

Regarding the second component studied, complementary health insurance (C2S), Health Insurance estimates the damage at 176.5 million euros. To arrive at this figure, the organization drew lots from 10,000 files and found that 8.7% of the beneficiaries exceeded the resource ceilings. In 1.22% of cases, income was even three times higher than the ceiling. But then, how to deal with this fraud? Well, there are a few leads.

First of all, you have to go through pedagogy. Indeed, while some breaches are voluntary, others are attributable to a lack of knowledge of the rules. It is for this reason that a support system for nurses was set up in 2021. In particular to educate on the rules of good invoicing. To combat complementary health insurance fraud, a pooled and automated system of collected resources has also been developed.

Health insurance: Several other works planned for 2023

With the development of the shared and automated system, it is impossible to forget to declare certain incomes. All Primary Health Insurance Funds will have access to this system from next July. The analysis of computer data using sophisticated tools should also enable more efficient detection. By the end of the year, the works concerning the frauds of general practitioners, physiotherapists, or even pharmacists should be published.

In 2023, it will be the turn of dentists, specialists and biologists. Again, the goal is to educate everyone. Because yes, there are not only fraudsters in France. It remains to know the next evaluations now. As soon as we have news, we will let you know. As per usual.

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