SURVEY FRANCE 2. The Health Insurance is suing for fraud against several ophthalmic centers

Medicare will not turn a blind eye to ophthalmology health centers. Elle has just closed a series of checks on certain institutions, suspected of fraud in the billing of medical documents. The agency is preparing to file four new criminal complaints, it told France’s “L’Œil du 20 heures” 2. These proceedings are in addition to 12 other complaints already registered this summer, as announced. Le Figaro, for “fraud, misrepresentation and misrepresentation”. In total, the damage is estimated at € 3.6 million as of October 2020, according to Securité sociale. Fifty other centers are under surveillance.

See the survey of “L’Œil du 20 heures”:

These establishments specializing in ophthalmology, which offer fast appointments, usually in third party pay (without any advance fees for the patient), have multiplied in the last three years, especially for a regulation associated with the conditions for the creation of health centers. . There are about 150 in France today, according to the Health Insurance, which has seen a sharp change in the costs associated with these facilities.

In 2020, these centers charged an average of 96.50 euros per patient, some even receiving an average basket of more than 150 euros, when a liberal ophthalmology and orthopathy firm charged an average of 63.50 euros per patient. “This is first-class routine care, there is no explanation for these cost differences.”explains to “The Eye at 8 p.m. “Dr. Catherine Bismuth, Director of Health Insurance Fraud.

“We found that a number of health centers were the main culprits with abuse of documents, or ‘optimized’ billing, but especially that we spotted billing atypies that were highly suspicious of fraudulent practices.”, details the director. For example, a practice called “fausse revoyure”, which consists of a first series of acts during the day of care, then several months later, when the patient has no income. Or the billing of an entire family, when only one person went to the consultation.

It is difficult for the patient to realize this at once, because these acts are automatically teletransmitted to Social Security and mutual societies, without any advance payment from his pocket.

The Social Security recommends that everyone regularly consult the accounts posted online in the personal space, and alert the primary health insurance fund if there is any problem. Finally, to go to a trusted facility, it is best to seek advice from your doctor.

Health Insurance Report on Expenditure on Expenditures and Products, July 2020, “Analyzing Atypical Practices in Certain Health Centers,” page 91

Syndicat National des Oftalmologistes de France

Non-exhaustive list

Leave a Comment