While the government is establishing a plan to fight against social fraud, a report shows that half of the fraud comes from health insurance, and more specifically from overbilling of health professionals who are singled out by the Court of Auditors .
According to the Court of Auditors, fraud in social benefits represents between 6 and 8 billion euros per year, half of which – around 4 billion euros – is against health insurance. 80% of these 4 billion would come from health professionals.
Indeed, in its report, the Court of Auditors, points the finger at many doctors, nurses or even physiotherapists who charge for medical acts never performed in order to be reimbursed by health insurance.
“No control since the health crisis”
For Pierre Moscovici, President of the Court of Auditors, “health insurance only checks 1 to 4% of the invoices issued by the various professions. No checks have been carried out since the health crisis on the invoices of health establishments. health. None. In 2022, the CAFs will only check on the spot 3% of the 3.1 million households benefiting from the RSA. And therefore, we must very clearly change scale, change speed. There are two things that must be made. First, the means of control must be increased. And then secondly, these controls must be better targeted. And all of this requires a certain political courage”, report our colleagues from franceinfo.
To mitigate this significant fraud, the Court of Auditors proposes several solutions, in particular that of setting up a dematerialization of medical prescriptions. This could make it possible to prevent the health insurance from medical acts which would not have been prescribed and which were invoiced. “The dematerialization of medical prescriptions can prevent the payment by health insurance of acts, goods and services which have not been prescribed or which have been in smaller quantities than those invoiced. In principle, most prescriptions, from a doctor in the city, in a medico-social establishment or in a health establishment, and executed by health professionals in the city, will have to be carried out by the dematerialized way no later than the end of 2024”, indicates the report .
“This report is not serious”
However, for Jérôme Marty, president of the union of liberal doctors UMFL, this report “is not serious”. “We expect something other than wet-finger reports that are only intended to push doctors, a profession that suffers enough,” he laments. “We have never seen thousands of doctors in court for such large sums. I do not think that the majority of my colleagues fake their prescriptions and I am not aware of repeated frauds”, assures the doctor. According to him, this report published in a tense context regarding the laws aimed at combating medical deserts in France, “casts opprobrium on the profession”.
Indeed, this study could pour oil on the fire between health professionals and elected officials, on the sidelines of the examination of the law to fight against medical deserts and the day after the rejection by the Assembly of an amendment tabled by a transpartisan group whose aim is to limit the freedom of establishment of caregivers. The profession is on a war footing: three unions of hospital doctors are calling for a “day of strike and action on July 4”.