False cancellations, billing for imaginary services, inconsistent actions… In the first half, the Health Insurance fraud detected and stopped amounted to 146.6 million euros. A figure that increases by 31% in one year, according to a first balance prepared this Thursday by the National Health Insurance Fund, which sets the goal of identifying 380 million euros of fraud throughout the year and then 500 million in 2024.
Of the total frauds detected in the first half of the year, the majority correspond to health costs that were made in the city (consultations, procedures, reimbursements for assistance and medications, etc.) and were invoiced incorrectly. In most cases, these are fictitious acts or overbilling by health professionals.
Thus, the amount of damages caused by fraud committed by healthcare professionals stood at 102.4 million euros (+19% in one year) during the first six months of the year, that is, more than two thirds of the Stopped damage. Fraud against policyholders amounted to 39.2 million euros (+45%).
More severe penalties
In recent years, Health Insurance has evolved its strategy in the fight against fraud. Sanctions have also been toughened. From now on, a liberal health professional (doctor, dentist, nurse) who has proven fictitious acts for significant amounts may be subject to a non-convention procedure, an ordinary complaint and a criminal complaint.
In total, during the period, 3,700 contentious proceedings were initiated, including more than 1,600 criminal proceedings, 25 ordinary proceedings and 26 conventional proceedings. “More than 1,000 economic sanctions worth almost 6 million euros have also been imposed to punish guilty or fraudulent actors,” adds Health Insurance.
Finally, remember that the 2023 Social Security financing bill allowed for increasing the maximum amount of the financial penalty up to 300% of the damage suffered.
Source: BFM TV
