THEHealth insurance announced the deregistration of seven health centers suspected of massive fraud, for an estimated loss of 6.6 million euros. This decision is part of a policy to strengthen the fight against abuse in the health care system. It aims to maintain the financial balance of Health Insurance and to guarantee the quality of care. We explain to you!
La Health Insurance fraud constitutes a major public health and budget management issue.
Far from being limited to a few isolated cases, it is taking on increasingly structured forms. As shown by the latest Health Insurance figures, fraud concerns insured persons as well as health professionals or institutions. In fact, 27% of scams are committed by health professionals, for 68% of total fraud amounts whilst 52% of fraud is committed by insured persons, for 18% of the total amounts.
Fraud attempts may involve fictitious medical procedures, multiple billing, or falsified records. The latest health insurance investigations highlight serious irregularities: Treatments not carried out, use of service doctors who are absent from the premises, or creation of artificial patient files.
What's the point of these practices? Allow some health centers to claim undue reimbursements on a large scale.
To learn more about Health Insurance figures and practices, listen to our podcast episode dedicated to The Marc Scholler interview
Faced with these observations, Health Insurance took the decision to Unconventional seven health centers located in Île-de-France, Bourgogne-Franche-Comté, Grand-Est, Brittany and Normandy.
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What is unconventional? In the event of a cancellation, Health Insurance covers the care provided in the center on a low reimbursement basis, this is what is called the authority rate.
This measure means that these centers will no longer be able to perform acts reimbursed at the usual rate by Social Security, but only at the authority rate - a very low level of reimbursement for patients.
Unconventional, effective as of April 15, 2025, constitutes a particularly heavy penalty in the health sector. She is translating the The authorities' desire to put an end to fraudulent practices while protecting policyholders.
This deregistering operation has several objectives.
First of all, deregistering makes it possible to put an end to the embezzlement of public funds in structures where the activity is based on fraudulent arrangements.
Next, this measure aims to send a dissuasive message to all actors in the health sector. The aim is to remind you that compliance with the rules is an essential condition to benefit from public funding.
Finally, it's about maintaining the quality of care and the trust of patients. The multiplication of centers with commercial logic leads to a lower quality of care. By sanctioning these excesses, Health Insurance intends to refocus the system on care that is really necessary and provided in medically and ethically acceptable conditions.
To continue reading, click here 👉 What anti-fraud insurance policy should be put in place?
To prevent excesses linked to fraud, one of the most promising levers is based on the use of automatic detection tools for false documents.
These technological solutions, based on artificial intelligence and data analysis, make it possible to identify the document fraud, anomalies in the files, or even the inconsistencies in declared practices.
These technologies can analyze massive volumes of data in real time, identify Suspicious patterns and alert the control services.
At Finovox, we have developed a solution for the detection of false documents. It allows you to analyze all types of digital documents, from any country and in any language! With our solution, strengthen the supervision of health centers and ensure regular monitoring of their practices. Do you want to know more about the Finovox solution? Contact an expert!
