Thanks to its efforts, Health Insurance detected 50% more fraud in 2023, or 466 million euros out of 247.6 billion euros in spending. It tracks “
all subjects of fraud
”, whether they come from “
health professionals, policyholders or companies
”, indicated Thomas Fatôme, the general director of Health Insurance. Prime Minister Gabriel Attal last week set a target of 2.4 billion in fraud detected and stopped over four years by 2027.
To achieve this, Health Insurance, which has around 1,500 agents responsible for combating fraud, is setting up 60 teams of cyber investigators. Operational from the third quarter of 2024, they will have judicial police skills to be able to infiltrate groups and networks which exchange tips and false documents online to abuse Health Insurance.
More than 200 centers controlled in 2023
More than 200 health centers were audited by the organization in 2023, and 21 were defunded for abuses such as billing for fictitious procedures, multiple billings for the same procedure or even unjustified care. The fraud thus stopped represents 58.1 million euros.
As for hearing aid professionals, Health Insurance is seeking to identify the scammers who have burst onto the market since the entry into force of 100% health insurance (generalizing reimbursement for hearing aids). Increased monitoring made it possible to detect 21 million euros of fraud in 2023 in this area. Health Insurance even obtained the criminal conviction of managers of a company who “
had deployed dozens of sales agents in nursing homes in France by passing them off as hearing aid specialists
”
.