It was long overdue, today it is a done deal. The Health Insurance has just presented to the Senate the first conclusions of its work undertaken in the fight against fraud. The least we can say is that the sum is incredible. Don’t worry, Objeko’s editorial staff will tell you everything on the subject. Are you ready?
Fraud is an important number
How much does Secu fraud represent? That has long been the question of the Court of Auditors. Well, today we have answers. Indeed, since the end of 2020, the Health Insurance has been conducting an extensive investigation to try to quantify the amount of fraud of which it is a victim. And this Wednesday, May 11, in the Senate, the first conclusions were presented. As you can imagine, the figure is in the tens of millions of euros.
For the first time, the Health Insurance took the example of the liberal nurses. In analyzing their 2018 billing data, the result is beyond appeal. Fraud is mainly estimated at between 286 million euros and 393 million euros. For information, during this year, Social Security reimbursed less than 5.7 billion. Fraud is mainly related to non-compliance with billing nomenclature as well as fictitious or multiple billing.
How to deal with this fraud?
Concerning the second component studied, the complementary solidary health (C2S), the Health Insurance estimates the damage at 176.5 million euros. To reach that number, the organization drew 10,000 records and found that 8.7% of recipients exceeded resource ceilings. In 1.22% of cases, the income was even three times higher than the ceiling. But then how do you deal with this scam? Well, there are some clues.
First of all, we have to go through pedagogy. In fact, while some shortcomings are voluntary, others are due to a mistrust of the rules. It is for this reason that a nursing support system has been set up in 2021. In particular to teach pedagogy on the rules of good billing. In order to combat complementary health fraud, a pooled and automated system of perceived resources has been developed.
Health insurance: Several other works planned for 2023
With the development of the mutualized and automated system, it is impossible to forget to declare certain income. All primary health insurance funds will have access to this system from next July. The analysis of computer data by sophisticated tools must allow for efficient detection and detection. By the end of the year, work on general practitioner, physiotherapist, or pharmacist fraud should be published.
In 2023, there will be a tour of dental surgeons, specialists and biologists. Again, the goal is to do pedagogy with everyone. Because yes, there are more than just fraudsters in France. It remains to be seen what future assessments will be. As soon as we have news, we give it to you. As usual.