Financial damage of 6.6 million euros. Health insurance has been diverted on Monday, April 7, seven health centers from the same network to France on Monday, April 7 for durations that go from 4 to 5 years. The reason? Fraudulent practices have been identified, he said Monday in a statement.
Health insurance has not mentioned the name of the criminal network. The disappointed centers can be found in Burgundy-French-Compté, Grand-Eest, Brittany, île-de-France and Normandía.
They were seen following the “inconsistencies” of billing in some of them, according to this press release. Then a national “force of tasks” was established to control the entire network, that is, nine centers.
In addition to the seven centers disappointed on Monday, one of the centers closed itself after the health insurance control, and another was the subject of a retirement of the operational authorization by the Regional Health Agency Grand Est, which automatically resulted in its final closure.
Billing of unrealized acts, acts carried out without the presence of the doctor.
“The investigations have revealed fraudulent and recurring practices in the nine centers, namely, the billing of inauos, acts carried out without the presence of ophthalmologist or orthaptist, or the systematic turnover of medical acts about the instructions given to the staff, without link with the medical state of the patient,” he said. “The general financial damage for health insurance exceeds 6.6 million euros,” he added.
The investigations were carried out “in close collaboration by the National Health Insurance Fund, and the Gendarmerie and its central office for the fight against illegal work (OCLTI), said health insurance.
“In the case of discontent, health insurance is responsible for care in this center on a very low reimbursement basis, known as the rate of authority,” he explains. “In fact, this diverts most patients to contact the center and, therefore, makes it possible to quickly avoid any health insurance damage.”
The establishment of the third widespread third as part of the 100% health reform, under the first mandate of Emmanuel Macron, facilitated the development of large -scale fraud in unscrupulous health centers. Patients have nothing to solve and, therefore, often do not verify the invoiced care in their name in health insurance.
According to health insurance, 52 in total health centers have been diverted since 2023, for around 90 million fraud detected and detained. In total, the fraud detected and detained by the health insurance, all the combined types, more than folded in five years, to 628 million euros in 2024, a jump that results from the increase in anti-fraud efforts, but also of the industrialization of scams.
Source: BFM TV
