“After the deconvention of five health centers in early 2023, Health Insurance is for the first time initiating a large-scale deconvention procedure, against 13 health centers of the same network, located in nine regions”, detailed the National Health Insurance Fund (Cnam) in a press release.
Concretely, from the effective deconvention, the Social Security will only reimburse the care practiced in these centers on a very low basis called the “authority tariff”, i.e. for example for an ophthalmology consultation at 30 euros a reimbursement of 1.22 euro, explains Health Insurance.
Seven people indicted last June
The Cnam accuses the ophthalmological and dental centers of the Alliance Vision group of “invoicing of fictitious acts and the repeated non-compliance with the rules of quotation and invoicing of acts”. These deconventions will take effect on August 21, 2023. The Cnam recalls that criminal actions targeting the centers of this network are in progress, after the filing of 27 complaints by the Primary Health Insurance Funds since June 2021.
An investigation followed: opened on July 6, 2021, it was then entrusted to an investigating judge on February 17, a judicial source told AFP, assessing the damage at more than 21.5 million euros.
Seven people were indicted on June 22 for organized fraud, money laundering and illegal practice of medicine, added this source, confirming information from Le Point.
Damage of 7.8 million euros
“The financial loss quantified by Health Insurance amounts to 7.8 million euros in the context of the complaints filed and could be reassessed in total for the entire network at nearly 21 million euros, according to the elements of the investigation, “said Cnam in the press release.
The Central Office for Combating Illegal Labor (OCLTI) is responsible for investigations. “These simultaneous deconventions of more than a dozen health centers, from the same network, send a strong signal”, reacted the director general of Health Insurance Thomas Fatôme, quoted in the press release.
In the process, Doctolib, a French heavyweight in making medical appointments and teleconsultation, announced that it had decided “in view of the seriousness of the facts”, to “immediately suspend all of the online services of these centers and to dereference them from its services”.