After the Orpea scandal, another group of Ehpads are pointed the finger. According to RMC, the company LNA Santé is the source of a health insurance fraud of almost 1.2 million euros.
A bucolic name for a seaside health facility in an idyllic setting: the Les Oiseaux health center in Sanary-sur-Mer. A reference institution, which has been caring for and caring for overweight children and adolescents for 90 years, and which is now under threat. For months, caregivers and educators have been sounding the alarm. The establishment will close in early July. Definitiveness. Le groupe LNA santé, which has about 80 establishments in France, mostly Ehpads and which bought Les Oiseaux in 2011, considers that the establishment is no longer quite “rented”.
If the names of Orpéa and Korian have been heard a lot in recent months, following the revelations of the investigative journalist Victor Castanet in “Les Fossoyeurs”, the LNA Santé company had become more discreet. However, it is one of the three listed health groups in France, which published in 2021 a net result tripled to 23.5 million euros. In this context, it is difficult for the staff of the Sanary center to accept the argument of profitability.
“It’s unacceptable. What will become of these children and young people who need this care? Profitability, we can’t hear it! Health is not a business, our children are not money gates, “laments Christel Pons, a dietitian at the institution for more than 30 years.
Her colleague, Alice Colin, a specialist educator, also laments the situation: “At a time when the pandemic has exploded obesity in France, one in three young people in Europe is affected by overweight In Europe, the establishment in the Var is being closed, which is the answer to this problem? This is total misunderstanding. “
‘Numerous malfunctions’ and ‘billing issues’
But why did the company want to close the center? In fact, the decision was made following an inspection by the Var Regional Health Agency in June 2019. “.
Specifically, for years, the LNA Santé group charged Medicare for days of coverage when the establishment was closed. In 2019, for example, the center closes five times for school holidays. The ARS mission notes that health insurance bills “did not offset these closing periods.” An organized system, after which “all the controls confirmed what I found”. Similarly, the days of the children’s absence were forged, such as an old doctor from the institution, who remained anonymous.
“What was happening was that the patient was coming out but he wasn’t being officially removed from the staff, so pricing could go on as if the patient was there when he wasn’t … It’s “It’s a way of making money on the backs of patients and on the backs of health insurance.”
In total, LNA Santé has billed almost 1.2 million euros in a totally improper way … In November, the Health Insurance sent a warning to the group, stating “anomalies of a fraudulent nature “, and requires a refund within two months.
Asked by RMC, Christophe Coquelin, director of operations for health activities at LNA Santé, said he had “never set up a fraud system” but had “resumed historical practices”. And to continue: “There have been some mistakes that have been made. That money has been returned. No one is supposed to ignore the law but not everyone knows the whole law.”
The LNA Santé group also assures that the closure of the institution was not directly linked to the fact that it had to put an end to the fraud system, but also acknowledged that the decision was taken at the same time. “It did not generate the decision, but it strengthened the decision that there was no possible economic model in this project,” admits Christophe Coquelin.
If the type of fraud is acceptable for criminal prosecution, no payment has been made through Assurance maladie contre LNA Santé. Asked by RMC, the Caisse nationale d’assurance maladie claimed to have “acted to preserve its financial interests which was important in notifying the undue and initiating criminal proceedings for fraud”. According to the CNAM, the establishment was fined 40,000 euros.
A somme in reality dérisoire by the ratio with the confused risk. Especially since the amounts actually defrauded could be much higher than the announced figures, the fraud being in place since the establishment of the establishment in 2011, and the Health Insurance has only gone back over a few years.
“Beyond the procedure for recovering undue bills provided for in the Social Security Code, the CNAM still has the opportunity to file a complaint with the Prosecutor,” said Master Emma Léoty, a lawyer specializing in financial law. Thus, in 2014, the Criminal Chamber of the Court of Cassation has already ruled that “the presentation of false invoices (to the CNAM) to obtain an undue reimbursement is a fraudulent maneuver” to convict a medical establishment on the basis of fraud . A fine of 7 years in prison and a fine of 750,000 euros.