“These centers are notably accused of having established false invoices and of having invoiced fictitious acts”, specifies the Health Insurance, which estimates the financial damage at nearly 1.5 million euros.
A rare decision. Two dental or ophthalmological health centers in Île-de-France were deregistered by Social Security for “fraudulent practices“, Health Insurance announced on Sunday. One is a dental health establishment located in Yvelines, the other dental and ophthalmological health establishment located in Seine-Saint-Denis. Precisely, they are located respectively in Trappes and Blanc-Mesnil, the National Health Insurance Fund (Cnam) told AFP, confirming information from the newspaper. The Parisian.
“In particular, these centers are accused of having established false invoicing and of having invoiced fictitious acts, that is to say not carried out“, specifies the Cnam in a press release. The financial loss for Health Insurance is estimated at nearly 1.5 million euros for these two centers.
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“In view of the seriousness of the facts and the amount of the financial damage“, the Health Insurance decided to deconvention them”for a period of five years without suspension“, indicates its press release. The measure takes effect from Monday for the center of Seine-Saint-Denis, and from February 1 in that of Yvelines. These deconventions are unprecedented for health centers, according to Health Insurance.
Health insurance checks
In concrete terms, this means that Social Security will only pay for care there on a very low basis, the tariff says “of authority“. For example, for an ophthalmology consultation at 30 euros, the reimbursement is only 1.22 euros. “Health Insurance therefore strongly advises its policyholders not to use these centers, a fortiori in view of the fraudulent practices that have been detected there.“, she says in her press release. The two primary funds concerned (CPAM des Yvelines and Seine-Saint-Denis) have filed a complaint, according to the Cnam.
Dental and ophthalmological health centres, the development of which has been favored to improve the supply of care, are in the crosshairs of many medical and paramedical professionals. The National Assembly voted at the end of November in favor of a stricter framework for these structures, some of which are presented as “cash machines“. In its press release, the Health Insurance says “strongly mobilized“in the control of centers that display billings”atypical“. She specifies that “88 dental health centers and 44 ophthalmological health centers are currently subject to checks by the health insurance funds“.