The number of frauds detected by Health Insurance skyrocketed last year. It increased by 50%, reaching almost 466 million euros. “This evaluation is the result of a proven anti-fraud strategy, with an acceleration of controls and a constant strengthening of human and technical resources,” says Health Insurance in an annual evaluation presented this Friday, March 28.
This branch of Social Security has more than 1,500 agents dedicated to the fight against fraud. And 300 new agents dedicated to this mission must be hired for the period 2023-2027, including 60 cyber investigators in 2024.
Health Insurance obtained better results than its initial target of 380 million euros detected for 2023. Last year, 10,500 judicial proceedings were initiated, resulting in nearly 4,000 criminal proceedings (+34% from 2022) and 3,400 financial penalties (+ 28%).
103 million euros in damages caused by pharmacists
If the insured are responsible for half of the frauds detected, more than 70% of the financial damages come from frauds committed by health professionals, “less numerous (almost 26%) but more costly,” says the Health Insurance.
Specifically, policyholders are responsible for fraud worth 91.1 million euros, “care and service providers” worth 330.2 million euros and healthcare establishments worth 45.1 million euros.
By profession, pharmacists occupy first place, being the only ones responsible for a fraud that reaches 103 million euros. The year 2023 was also marked “by the continuation of important campaigns aimed at fraudulent health centers and hearing professionals,” Health Insurance highlights. Since 2021, no less than 200 healthcare centers have been audited, which has translated into more than €58 million in fraud detected and stopped in 2023.
Health centers in the spotlight of Health Insurance
“For the first time, an entire network of 13 health centers in 10 departments was defunded due to overbilling,” the government said on March 20, within the framework of the presentation of its report on the plan against social, tax and customs fraud. .
More than 160 hearing aid companies are currently being monitored for “suspicions of false or fictitious billing,” Health Insurance added this Friday. A dozen of them have already been annulled since the beginning of 2024, while last year more than 300 criminal complaints were filed against hearing professionals.
As for the insured, “cash” fraud (pensions, allowances, disability pensions, etc.) constitutes the main damage, amounting to 38.7 million euros in total, with 4,000 cases affected in 2023.
According to the government, last year pharmacists reported 11 million fake prescriptions and 5 million fake work stoppages were detected online.
Source: BFM TV
