Mutuality judges can “stop” 2.4 billion euros in social fraud, if complementary health is authorized to share health insurance information to identify scammers, health professionals or individuals.
In 2024, health insurance managed to detect and stop 628 million euros in fraud (excluding fraud with respect to additional health), of a total amount of fraud generally estimated at 4 billion euros.
“We do the same job twice without communicating”
To identify the scammers, it is necessary to “finally give the legal means to share the data” between health insurance and complementary health, Mutuality indicates in their note. It is also necessary to “give an indisputable legal basis for the mission of the fight against fraud of complementary organizations”, and “strengthen the fight against scammers,” he believes. Complementary health insurance should be informed in particular when health insurance suspends a third party for a health professional due to the suspicion of fraud, to also be able to suspend it for its services, he explains.
In order to exchange information with health insurance, complementary health insurance needs new legislative provisions. They hoped to touch the objective in the SAP 2025 budget, but the provisions in this regard introduced during the debates in Parliament were finally rebuilt by the Constitutional Council, because it was a legislative pilot.
Open to paramedics of acts reserved for doctors
Among its other proposals to make health expenses more efficient, mutuality recommends continuing to open acts to paramedics so far reserved for doctors, as a recipe for care. It also recommends establishing “generalized coverage” for loss of autonomy linked to aging, by supporting complementary health.
Source: BFM TV
