Health Insurance’s increased efforts in the fight against fraud, in 2023, enabled it to increase fraud detected and stopped by 50%, to 466 million euros, she announced on Thursday March 28. This increase is “the fruit of the mobilization of Health Insurance on all issues of fraud”whether it comes from “health professionals, policyholders, businesses”declared Thomas Fatôme, Director General of Health Insurance, presenting the annual report of his institution in this area.
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. The Prime Minister, Gabriel Attal, set a target last week 2.4 billion in fraud detected and stopped, over four years, by 2027.
Health Insurance has around 1,500 agents responsible for combating fraud. In particular, it is in the process of setting up teams of cyber-investigators, grouped within six interregional centers (Blois, Grenoble, La Rochelle, Lille, Marseille and Paris).
200 health centers monitored
These cyber investigators – sixty 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. The teams will be operational “from the third quarter of 2024”specified Marc Scholler, the deputy director of audit, finance and the fight against fraud at the National Health Insurance Fund.
By field of activity, health centers (ophthalmology, dental) and hearing aid specialists are particularly monitored today by Health Insurance.
More than 200 health centers were audited by Health Insurance in 2023, and 21 were defunded 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 that 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 sector.
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.