Health Insurance will launch a control campaign on 130 hearing aid companies in France to verify their practices (AFP/Archives/Patrick T. FALLON)
Health Insurance will launch a control campaign on 130 hearing aid companies in France to verify their practices, while this booming sector is marked by significant fraud.
“We are launching an action plan concerning 130 hearing aid companies, which we will visit on site, to look at their files, and initiate administrative and criminal sanctions if necessary,” declared Thomas Fatôme, the director General of the Health Insurance Fund, who presented on Thursday a progress report on Health Insurance’s anti-fraud efforts.
In fraud linked to hearing aids, hearing aid centers bill the Health Insurance for prostheses which have never been fitted, bill for expensive equipment when they have fitted simple equipment or equip people who have not don’t need it…
The hearing aid market was boosted by the introduction from 2019 of 100% health (offer allowing complete coverage of prescription glasses, dental prostheses or hearing aids), which enabled many people to ‘equip when they couldn’t before.
From 2019 to 2022, prosthetic installations have doubled, going from 400,000 people equipped per year to 800,000.
Health Insurance reimbursements, for their part, reached 420 million euros in 2022, compared to 180 million in 2019, recalled Mr. Fatôme.
But this market takeoff has been accompanied by the arrival of unscrupulous players, who sometimes even display false diplomas, according to Health Insurance.
In total, given the first checks and anti-fraud procedures launched, fraud linked to hearing aids “could represent several tens of millions of euros”, according to Mr. Fatôme’s estimates.
For this estimate, Health Insurance is based in particular on the results of a recent inspection campaign in Seine-Saint-Denis, the figures of which are edifying.
– Undercover cyber investigators –
According to the director of the Primary Health Insurance Fund (CPAM) of Seine-Saint-Denis Aurélie Combas-Richard, “17% of the invoices currently arriving are fraudulent”.
The in-depth control campaign launched by this Fund has made it possible to avoid “3.7 million euros” in undue reimbursements since January, she said.
In total, 14 criminal complaints were filed by the CPAM of Seine-Saint-Denis, said Ms. Combas-Richard.
Two companies with fraudulent practices have been placed in liquidation for having received 2.3 million euros in an undue manner.
One of them “tried to transfer funds abroad”, but the transfer was blocked thanks to joint action with the police, she also said.
According to Health Insurance figures, there are today 6,700 companies installing hearing aids in France, while there were 1,500 in 2020.
By drawing up this overall “mid-year” assessment of the fight against fraud on Thursday, it estimates that it has managed to detect and stop 150 million euros of fraud in the first half of the year and considers itself on track to achieve the objective of 380 million in total in 2023, compared to 315.9 million in 2022.
Two thirds of these frauds stopped in the first half of the year relate to community care, mainly in the form of fictitious acts and overbilling by health professionals.
Figures to be compared to the total expenditure of Health Insurance, of the order of 200 billion euros per year.
Health Insurance is in the process of strengthening its anti-fraud workforce, with 300 hires planned to reach a total objective of 1,800 specialists in 2027, she also indicated.
In particular, it plans to hire 60 cyber investigators. These sleuths will have the right to carry out investigations under a pseudonym, to infiltrate the forums and messaging services where good fraud tips are exchanged, as well as false prescriptions and false sick leave notes.
© 2023 AFP
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