Patients will still be able to go there, but they will no longer be reimbursed – or on a very low basis of 1 euro and dust, for a specialist consultation billed 30 euros. Two dental and/or ophthalmological health centers, one located in Trappes (Yvelines), the other in Blanc-Mesnil (Seine-Saint-Denis), were deconventioned by Medicare for “fraudulent practices” whose damage amounts to nearly 1.5 million euros, said Sunday, January 22, the latter.
The first offers dental care only, the second adds ophthalmology procedures. This deconvention decision – a first, the organization informed –, taken for a period of five years without suspension, was to take effect on Monday January 23 for the center of Seine-Saint-Denis, the 1er February for that of Yvelines. It was decided with the favorable opinion of the members of the departmental joint committees.
The recent opening of these two centers – one in 2021, the other in 2022 – in territories which, as elsewhere in Ile-de-France, are not immune to medical desertification, had been well welcomed by the locals. It’s from them that the alerts came at Blanc-Mesnil, reports The Parisianwhich revealed the two cases: compulsory Covid tests, prescriptions offered to companions, double billing… Over the months, patients have opened up to these abuses.
In Trappes, the internal investigation carried out by the Primary Health Insurance Fund of Yvelines and cited by The Parisian estimated the damage at 1 million euros, for nine months of activity. “These centers are notably accused of having established false invoicing and of having invoiced fictitious acts, that is to say not carried out”, said Sunday, Medicare. In both cases, the two primary funds concerned filed a complaint.
Very serious deviations
Dental and ophthalmological centres, the development of which has been favored to improve the supply of care, particularly in areas where medical demography is not sufficient to meet needs, are in the crosshairs of many medical and paramedical professionals. In the fall of 2022, Medicare communicated on a “reinforced strategy” of the fight against fraud. Strategy based on new legislative levers, in the Social Security financing law of 2022 as in that of 2023.
The National Assembly voted at first reading, on November 30, on a bill put forward by MP Fadila Khattabi (Renaissance, Côte-d’Or) in favor of stricter supervision of these centres, and in particular of a prior approval from the regional health agencies for those who provide dental or ophthalmological care. With, as a backdrop, the memory of the Dentexia and Proxidentaire scandals which, in 2015 and 2021, brought to light very serious abuses. The text must be examined in the Senate in mid-February.
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