The end of the year promises to be busy for parliamentarians. Among the Social Security financing and financing bills by 2026, they will also have to examine another text, at the initiative of the Government, which aims to fight social fraud.
And for a good reason, only by 2024, it is estimated at not less than 13 billion euros. While the State seeks substantial savings, 43.8 billion euros, including 5,500 million health next year, it is urgent to act.
But where do these security fraud come from? Contrary to popular belief, “they are not limited to insured and vital cards,” said the National Health Insurance Fund (CNAM). “Fraud are complex, mixing isolated practices and organized networks.”
68% of the amounts detected are frauded by health professionals
According to CNAM figures, in 2024, 52% of the volume fraud is committed by insured, against “only” 27% by caregivers in the city and 21% for establishments.
But as an amount, the trend is very different: health professionals in the city have the origin of more than two thirds of the fraud and detected amounts last year, 68% precisely, against only 18% for the insured. Health establishments are responsible for 14% of disappointed amounts and identified by cells to combat safety fraud.
Without surprise, an important part of these fraud is linked to hearing centers whose fraudulent behaviors detected are exploited.
Health centers, which grow as fungi in the territory in recent years, are also closely controlled. In fact, they are at the origin of 39 million euros in fraud in 2024, which led to the disappointment of 30 establishments that year (against 21 in 2023).
Billing errors that cost expensive
Another important part of the fraud is also explained by billing errors committed by health professionals, and not necessarily voluntarily. In its “positions and products” published at the end of June, the CNAM emphasizes that the social hole is partly due to billing errors committed by masseuses-fisiotherapists, estimated at 660 million euros. They attend 566 million for liberal nurses or 502 million euros for pharmacists.
These amounts are considered “anomalies” by health insurance because it is, for example, for physiotherapists and nurses, the error billing of acts provided as a 100% security support for patients with long -term affection (ALD), while care is not in direct contact with the ALD. For pharmacists, it may be the billing of medications not registered in prescription, or even the issuance of a treatment in greater quantity than the necessary amount prescribed during the period.
However, health professionals are not always in good faith: “The fraud of nurses, for whom the damage detected and detained amounts to 56 million euros, are mainly billing of unpaid acts, falsification of prescriptions or double billing,” said the CNAM. “As for carriers, the billing of unpaid transport, kilometric surcharges or even the falsification of recipes explain an amount detected and detained at 41.5 million euros,” he adds.
Source: BFM TV
