A registration evaluation. In 2024, 628 million euros were detected in fraud and stopped in health insurance. An amount of 35% that largely exceeds the initial objective of 500 million euros established last year. “Since 2021, the results have tripled,” says health insurance.
Of these 628 million euros, 263 million fraud (+55%) are avoided. This means that they were detected before health insurance even suffers damage. “This is the priority theme of our strategy: avoid fraud acting in advance.” She emphasizes. These frauds were avoided thanks to “many directed a priori” that “that” aimed to stop fraudulent behavior even before health insurance payments and, therefore, avoid unjustified expenses. “
The antiphrauda for health insurance is based on more than 1,500 agents. And 300 new agents dedicated to this mission must be recruited for the 2023-2027 period.
68% of the damage linked to fraud committed by professionals
If the insured is responsible for half of the fraud detected (52%), 68% of financial damage comes from the fraud committed by health professionals in the city that, therefore, are less numerous but more expensive. In comparison, insured’s fraud represents 18%of financial damage, before the fraud of health establishments (14%) and that of employers (0.3%).
By profession, it was the headphones who were at the origin of the greatest financial damage (115 million euros detected, +441%) in 2024. Then they come pharmaceuticals (62 million euros, +3%) and nurses (56 million, +11%). With respect to them, fraud “is mainly billing of unrealized acts, falsification of recipes or even double invoices,” says health insurance. The scammers caused a prejudice of 42 million euros (+22%) more frequently in the billing of unpaid transport, mileage overloads or even in the falsification of prescriptions.
In addition to the health centers (-28%) and the general professionals (-47%), the “results of the fight against fraud committed by health professions have generally increased for each category”, which “reflects the effectiveness of reinforced controls and the actions prior to the equity implemented,” concludes health insurance, while specifying that “these frrities remain limited to the minorities of the actors.”
Source: BFM TV
