Marc de Beaucorps, CEO of Finovox, had the pleasure of talking with Marc Scholler, Deputy Director of theHealth insurance in charge of Finances, Fraud Control and Audit. Impact of documentary scams on the Health Insurance system and on public finances in general, the most common types of fraud, staff awareness or even public policies, discover a brief excerpt from their conversation.
Marc de Beaucorps:
What are the major frauds or major issues that you need to counter?
Marc Scholler:
There is a first paradox that we are trying to fight against by communicating our results in the fight against fraud.
Indeed, in the collective imagination, for a long time, the idea was conveyed that health insurance fraud was a fraud mostly of insured persons in our databases, from abroad who take advantage of the system. I can't deny that it exists. However, the first paradox is that fraud represents 466 million in 2023 and is made up 70% of healthcare professional fraud.
Fraud by health professionals is linked to a series of measures, in particular third-party payment. Indeed, most of our financial flows are directed to health professionals. This represents around 320 million euros in 2023 which are distributed unevenly according to professional specialties.
We must therefore break this preconceived idea that fraud is a matter of insured persons who benefit from unjustified rights. In reality, fraud by health providers is generally professionals who bill us for treatments that were not performed Or so who are billed for higher amounts to the amount of the service actually provided.
This may seem a bit surprising, but insurance systems systematically cover healthcare expenses or, in the event of work stoppages, compensation for wages.
Health insurance is a tripartite system based on trust that is materialized by documents. So it is It is important that we can check these documents to ensure that the service took place.
To find out more about health insurance fraud, we wrote an article on the subject: health insurance fraud Want to listen to the podcast to find out more about health insurance fraud? Do not hesitate any longer and click below!
