Nurses pointed the finger at health insurance for fraud

According to Assurance maladie, a number of liberal nurses are responsible for fraud and the financial damage is high.


Nurses Pointing Finger at Fraud Health Insurance / iStock-Christopher Ames

An investigation commissioned by the Court of Auditors

The Court of Auditors has asked Health Insurance to investigate the reimbursement of city nursing reimbursement fraud. The objective? “Better knowledge of financial losses, by type of risk, to better detect and sanction them, but also consolidate all actions to prevent fraud.” The Health Insurance survey covers “only” 3,624 cases (inspected in 2018). Of this total, 1,370 (38%) have various irregularities. The agency relied on these records to measure the extent of fraud nationwide. According to the body, the financial damage would be between 5 and 7% of the payments, for an amount including between 286 and 393 million euros (general scheme). It should be noted that the budget for reimbursable expenditure is € 10 billion, not € 7.5 billion for the general scheme. Note: for Assurance maladie, a liberal nurse who received € 200,000 in honor for a suspect. Or, in 2018, 2.1% of nurses charged more than € 210,000 in fees …

Fraud: How Do Nurses Proceed?

More comments do nurses pour frauder? Some increase their mileage allowances, a “cheat” that accounts for 62% of fraud cases and 39% of overall financial damage. Others charge imaginary benefits and still others multiply the bills for the same act (22% of cases, 38% of financial damage). Some have opted for non-compliance with the nomenclature of acts and referring too high facts to the Social Security and other cases of fraud to the prescription. Finally, in rare cases, the profession is practiced illegally.

A surprise? Really step!

Is Health Insurance Surprised by These Names? Really step. The number of Liberal nurses is close to 100,000. However, few checks are carried out. How can it combat this costly phenomenon? In uses artificial intelligence for automated data processing. In addition, now, any liberal nurse caregiver who is installed must go through a blank check and then, eight months after its installation, it is the subject of a real check. And, since the beginning of the year, a monthly resource device (DRM) has been launched. At the end of the following year, other occupations will be affected by health insurance: health carriers, general practitioners / specialists, masseurs kinésithérapeutes…. to laboratories.

Complementary health fraud is also scrutinized

Liberal nurses are not the only ones to have been investigated by the Court of Auditors at the request of the Health Insurance Board. Complementary health care fraud is also being looked at closely. The Health Insurance estimates that there is fraud from the moment when the insured’s resources are three times higher than the ceiling (just over 9,200 euros for a single person and about 19,320 euros for a couple with two children ).

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