For our Chasseurs de Fraude podcast, Marc de Beaucorps, CEO of Finovox, interviewed Anthony Jabre, Director of Medical and Claims Management at Malakoff Humanison 14 February 2024. In this 30-minute interview, the two experts talk at length about document fraud in healthcare. Together, they analyse the trend and reflect on the best ways to combat forged documents in the long term. It's a challenge when you consider that most healthcare fraud involves a healthcare professional. That's the subject of the extract we bring you in this article.
Anthony Jabre 78% of frauds involve a healthcare professional. And this is somewhat at odds with the image we have of fraud. We often imagine a young person falsifying a document or getting caught on social networks. But it's not. It's something quite organised and institutionalised.
The bands are not very clear. There are those who overcharge, who exaggerate. Some are fictitious, billing for something that is not exactly what was given. That's where the iceberg really lies.
Afterwards, when we talk about fraud, we tend to talk about other, more noteworthy events, because they involve people who really wanted to defraud, and that's remarkable. But most fraud today is systemic.
Marc de Beaucorps The 78%s are only healthcare professionals who have sent you false information, false invoices and who have therefore committed fraud? Or are they in collusion with their customers?
Anthony Jabre Both schemes exist. There is collusion, even network fraud, involving healthcare professionals with several policyholders, in more or less elaborate schemes.
The bulk of fraud today is abuse, if we take a slightly broader term, because it is even to the detriment of the insured person who is unaware of it. The French healthcare system is set up in such a way that people often don't pay when they go to a healthcare professional. You don't pay because it will be covered by the carte vitale, or by third-party payment, which is, in fact, the supplementary scheme. If the insured person doesn't pay, whether it costs 50 or 500 euros, we're not going to tell them. And then, will he go and check?
Want to find out more about healthcare fraud with Anthony Jabre? Listen to the full episode by clicking on the link below.
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