Complementary health care fraud: the first assessments

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In 2021, health insurance fraud amounted to 220 million euros. Following a request from the Court of Auditors, the Health Insurance is conducting an investigation to find out the mechanisms of this fraud. This Thursday, May 12, the organization revealed its first assessments were diverted via the complementary solidarity health.

25 million CSS fraud

corpse health expenses increased in 2021. Mutual health supported one 21% increase expenses paid. Health Insurance, meanwhile, has seen an increase of 9.2% of refunds. Every year, on the whole of the benefits paid, in some of them the result of a fraud in social security.

To understand its origins, the Social Security is conducting various investigations. Yesterday, Thursday, May 12, these are the first assessments of the complementary health care fraud (CSS) that have been unveiled. She would represent 1.22% of the totality of the benefits paid either 25 million euros.

More Comments Did Health Insurance Define Fraud? The national credit union qualifies as fraud when the insured owns actual revenue 3 times the CSS ceiling. Thus, if a person makes a statement, then that his resources are 1 to 3 times higher than the ceiling, it is considered as one error and not as a fraud.

These errors would amount to 176.5 million eurosor 8.7% benefits paid, which is a significant loss. The Health Insurance considers that the sub-statements of revenue are the source of 15% of CSS fraud.

Misappropriated sums less than non-remedies

Today, 7.1 million insurances are beneficiaries of this solidary health coverage. Hundreds of people should not be sued for fraud, of course. How much more is missing on call?

The Health Insurance estimates that the amount of fraud is less than that of the non-recourse. This term refers to policyholders who are eligible for social assistance but who have not declared themselves and therefore do not receive it. What would be close to 5 million of additional persons who would be affected by complementary solidarity health. This is equivalent to 2 billion euros unpaid benefits.

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