On May 19, we had the privilege of welcoming two speakers for a webinar around a major issue: document fraud in the public sector. Led by Marie Lottier, Partner and Marketing Director at Finovox, this exchange allowed Julien Lasalle, Deputy Director of Payment Studies and Supervision at the Banque de France, and at Marc Scholler, Deputy Director of Health Insurance, in charge of Finances, Fraud Control and Audit, to discuss the new challenges related to fraud. Back to this discussion!
In a context of dematerialization of services, where the speed of exchanges sometimes seems to take precedence over the verification of information, false documents are proliferating. Falsified pay slips, fake prescriptions, modified invoices, fake diplomas... operating methods are diversifying. The stakes are colossal, both in terms of financial costs and institutional trust.
To the National Health Insurance Fund (CNAM), out of the 250 billion euros in health spending per year, 627 million euros in fraud were detected in 2023.
While the figure may seem marginal, it is in fact significant. Fraud is better and better identified, but it is constantly evolving.
“Insured persons are not the main fraudsters, but a minority of health professionals. Around 70% of the fraud detected concerns them,” said Marc Scholler.
The operating methods are varied: fictitious acts, obtaining social rights based on false documents or even abusive prescriptions. Taking the example of fraud in hearing aids with fake diplomas, the Damage amounts to 115 million euros.
On the side of Bank of France, the numbers are just as worrying.
On 35 000 billion euros in payment flows annuals, 1.2 billion euros are linked to fraud. If this rate is low in proportion, the impacts are real: modification of the IBAN on invoices, falsification of checks, or manipulation of documents when subscribing to services.
“Document fraud is often the gateway to fraud involving means of payment. It makes it possible to alter reality in order to redirect funds to fraudsters,” explained Julien Lasalle.
The Covid-19 pandemic marked a turning point. With the generalization of teleworking And the dematerialization of procedures, the control devices have been shaken up. Loopholes appeared, which were quickly exploited by fraudsters.
The CNAM evokes a radical transformation: society has gone from an artisanal fraud to an industrialized fraud. Of fraud kits circulate, and mules are recruited to act as intermediaries.
For its part, the Banque de France noted an explosion in phishing and smishing attacks, taking advantage of the digitalization of communication channels.
Fraudsters impersonate, modify digital documents, and trick their victims with virtually undetectable interfaces.
Coordination between institutions is essential.
The Banque de France uses several mechanisms to secure exchanges:
For his part, Marc Scholler explains that the CNAM must deal with 1.5 billion billing flows every year.
Each act is potentially accompanied by supporting documents (prescriptions, prescriptions, etc.), whether paper or electronic.
The institution then set up three levels of control :
1- A priory : via an information system that filters the documents in order to verify the conformity of the documents
2- A posteriori : with an analysis of statistical anomalies using criteria for targeting atypia.
3- Advanced digital controls : they are still under development and are not fully integrated into the processes.
The direct amounts are massive, but the indirect costs are even more worrying.
The CNAM mobilized 1,600 employees to strengthen its systems (lawyers, data scientists, doctors, etc.).
“Fraud in a universal public system is intolerable. It creates injustice: those who evade benefit unduly, while honest citizens suffer,” insisted Marc Scholler.
The CNAM recently carried out the deregistering of several health centers after identifying repeated fraudulent practices. These structures hijacked the system by charging fictitious acts. at the expense of public finances and the confidence of insured persons.
For banks, the complexity is all the greater because falsified documents are often in the hands of customers. It is therefore necessary to strengthen the Vigilance of bank agents, while investing in technologies for the automated detection ofartificial intelligence.
Marie Lottier, Partner and Marketing Director at Finovox, asked a central question: why is fraud developing so much?
The answer seems clear and unanimous: ease of access and the feeling of impunity.
“For some, falsifying a document has become as easy as ordering a pizza,” ironically Marc Scholler, Deputy Director of Health Insurance
In a society of instantaneity, where everything must go quickly, controls are often experienced as an annoyance. However, they are essential!
To find the Marc Scholler podcast episode: Marc Scholler, Deputy Director of Health Insurance in charge of Finances, Fraud Control & Audit
The two institutions converge on several points.
For Marc Scholler from CNAM, you need to:
For Julien Lasalle from the Banque de France, you need to:
“Small-scale fraud should not be overlooked. They are massive, very discreet, and often invisible to the general public. However, their impact is real,” underlined Julien Lasalle.
To find the Julien Lasalle podcast episode: Julien Lasalle, Deputy Director of Studies and Payment Supervision at the Banque de France
For Julien Lasalle, the future passes through a close consultation between ecosystem actors. From public institutions to private actors to law enforcement agencies, everyone must cooperate. The fight against cybercrime is a collective challenge.
Marc Scholler pleads for a faster detection capability, through tools capable of instantly identifying a falsification.
According to Marie Lottier, “The fight against documentary fraud is a real game of cat and mouse. You always have to stay one step ahead.”
At Finovox, we are proud to have enabled this exchange and to contribute to raising awareness about the risks associated with document fraud. Interested in this topic? We regularly organize anti-fraud mornings in places steeped in history, to combine conviviality, culture and the sharing of expertise around this crucial subject.
If you want to see what our last morning was like, click here: Anti-fraud morning: a key event to prevent and counter fraud risks
To go further, discover our automated documentary analysis solution, and let's stay on the lookout together in the face of a constantly evolving phenomenon.
