For our Fraud Hunters podcast, Marc de Beaucorps, CEO of Finovox, welcomed Anthony Jabre, Medical Director and Claims Management at Malakoff Humanis, February 14, 2024. In this 30-minute interview, the two experts discuss at length the subject of documentary fraud in health care. Together, they analyze the trend and reflect on the best ways to combat counterfeit documents in the long term. A challenge when you know that the majority of health scams involve a professional in the field. This is the subject of the excerpt that we offer you in this article.
Anthony Jabre : 78% of fraud involves a health professional. And that goes a bit against the image we have of fraud. We often imagine a young person forging a document or getting caught on social networks. While no. It's a fairly organized, institutionalized thing.
The bands are not very clear. Some are going to be overbilling, exaggerating acts. Some are going to be fictional, in charging for something that is not exactly what was given. That's where the iceberg really is.
After that, when we talk about fraud, we tend to talk about other, more significant events, because they involve people who really wanted to defraud and that's remarkable. But the bulk of fraud today is systemic.
Marc de Beaucorps : The 78% are only health professionals who sent you false information, false invoices and therefore who have defrauded? Or are they in collusion, let's say, with customers?
Anthony Jabre : Both schemes exist. There are even connivances in network fraud that involve health professionals with several insured persons, in more or less elaborate schemes.
The bulk of the bulk of fraud today is abuse, if we take a slightly broader term, because it is even at the expense of the insured who is not aware of it. The French health system is designed in such a way that, often, you don't pay when you go to a health professional. We don't pay because it will be covered by the Carte Vitale, or by the third party payer, which is, in fact, the complementary regime. The insured, as long as he does not pay, whether it cost 50 or 500 euros, well we are not going to tell him. And behind, will he go check?
Want to learn more about healthcare fraud with Anthony Jabre? Listen to the full episode by clicking on the link below.
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