an increase of 50% in one year
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The National Health Insurance Fund (Cnam) presented this Thursday its annual report on the fight against fraud. Results: a record amount of more than 466 million euros was detected and stopped in 2023. A figure up 50% compared to 2022.
Identity theft…
These frauds can include identity theft, falsification of work leave, drug trafficking by insured persons, as well as overbilling or invoicing for fictitious acts of care by professionals or health establishments.
This increase is “the fruit of the mobilization of Health Insurance on all issues of fraud”, whether this comes from “health professionals, policyholders, companies”, underlines Thomas Fatôme, the general director of health insurance.
Health Insurance plans to further increase its efforts in the years to come, to reach 700 million euros of fraud detected and stopped in 2027. Prime Minister Gabriel Attal set a target of 2.4 last week. billion in fraud detected and stopped over four years by 2027.
1500 agents mobilized
Health Insurance has around 1,500 agents responsible for combating fraud. In particular, it is setting up teams of cyber investigators, grouped within six inter-regional centers (Blois, Grenoble, La Rochelle, Lille, Marseille and Paris).
These cyber investigators – 60 in total – will have judicial police skills to be able to infiltrate groups and networks which exchange tips and false documents online to abuse Health Insurance. These teams will be operational “from the third quarter of 2024”, indicated Marc Scholler, deputy director of audit, finance and the fight against fraud at Cnam.
Targeted health centers and hearing aid professionals
By field of activity, health centers (ophthalmology, dental) and hearing aid specialists are particularly scrutinized today by Health Insurance.
More than 200 health centers were audited by Health Insurance in 2023, and 21 were canceled for abuses such as billing for fictitious procedures, multiple billings for the same procedure or even unjustified care. Fraud detected and avoided in these establishments represents 58.1 million euros, eight times more than in 2022.
As for hearing aid professionals, Health Insurance seeks to identify and stop the scammers and unscrupulous companies who have burst onto the market since the entry into force of 100% Health (generalizing reimbursement for hearing aids). Increased surveillance of Health Insurance made it possible to detect 21 million euros of fraud in 2023 in this area.
The total amount of benefits paid by Health Insurance in 2023 was 247.6 billion euros, according to figures from the Social Security financing law passed in December by Parliament.
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