More cooperation with complementary health insurance, this is one of the shock proposals of the National Health Insurance Fund (CNAM) to strengthen the fight against fraud in the health system. Far from being new, the idea appears in its report “positions and products” presented on Tuesday, June 24. It stops the intention of shedding light on public and parliamentary authorities for the next security budget by 2026, this 247 -page document highlights from the boxes a measure that, however, had been censored from the Social Security Financing Law (LFSS) by 2025.
It is about developing the exchange of information between the main funds of health insurance (CPAM) and complementary organizations “to make the fight against fraud even more efficient,” maintains the CNAM. “If they will be useful to the insured, these exchanges have an obvious interest in health professionals, in order to quickly stop unjustified reimbursements,” he institutes.
Problem, this measure was considered a social rider by the Constitutional Council, considering that it did not take place in a budget text.
A bill under study
The elected representative of the RHône also presented a bill on May 13 at the National Assembly, aimed at facilitating (finally) the exchanges between CPAM and complementary health. In its current state, the text, which could be examined this fall, first provides “that the health insurance funds are communicated, in case of a fraud complaint, the name and contact data of the complementary organizations assigned by this fraud to the prosecutor.”
For the sake of respect for medical confidentiality, it is also specified that “only the strictly necessary information for the identification of the author of the facts of suspicious fraud can be communicated by the health insurance with complementary health.”
If the parliamentarian initiative is well received by complementary organizations, the three federations of the sector: La Mutualité Française, the insurers of France and the Technical Center for the Provident Institutions (CTIP), are still waiting for an “essential provision of the average, indicates the processing of health data by the complementary health insurance organizations within the frame Business fraud. ” -Marie Issanchou, Health Director of the French Mutuality Federation (FNMF).
628 million euros in fraud detected and detained in 2024
According to health insurance figures, no less than 628 million euros were detected in fraud and stopped in 2024. “A record results in financial damage” according to the CNAM, since it has increased more than one third compared to 2023 (+34%).
“More than half of the fraud detected is committed by insured, for only 18% of the amounts, the CNAM details. The fraud committed by health professionals represent almost 26% of the fraud in number, but for much higher quantities, or 62% of the damages.”
Source: BFM TV
