Over-invoicing, over-treatment, questionable and unethical practices… The misuse of the health center model by some managers could soon be a thing of the past.
In any case, this is the subject of an amendment to the social security finance bill (PLFSS) adopted Wednesday in the social affairs committee which aims to give a stricter framework to the installation and the activity. of these structures, in particular in the dental, ophthalmological and gynecological fields.
Taking up one of the recommendations of the last Expenses and income report submitted in July by the Health Insurance to the National Assembly, this text notably puts an end to the automatic agreement in force for health centers.
“Until now, anyone could create their own dental or ophthalmological center, etc., explains Fadila Khattabi, LREM MP for Côte-d'Or and president of the Commission des Affaires sociales.
From now on, it will be necessary to make an agreement with a visit beforehand to see if things are in good and due form.
»With particular attention paid to the quality of care provided and the seriousness of the practitioners recruited.
76 complaints from patients sometimes mutilated during dental treatment
If the amendment is retained in the PLFSS, the structures not adhering to the national agreement or deconvented following a sanction would be applied at authority tariffs, much lower than the agreed tariffs. They would also lose the benefit of the “Teulade” subsidy, ie health insurance coverage of part of employee contributions. The means of sanction, available to the director of the Regional Health Agency, would also be increased with the creation of an administrative fine of a maximum amount of 150,000 euros together with a fine of 1,000 euros per day.
Fadila Khattabi's initiative comes a few days after the final closure of the Proxidentaire centers of Chevigny-Saint-Sauveur (Côte d'Or), located in her constituency, and Belfort. Their activity had already been suspended by the Regional Health Agency since this summer after the filing of 76 complaints from patients denouncing ill-treatment, mutilation and financial abuse.
The victims, organized collectively, were also received at length by the deputy who also intends to fight for "the right to continuity of care for these mutilated people: some are 45 years old and an unusable denture, there is a young 24-year-old whose incisors were removed…, lists Fadila Khattabi.
They are in terrible physical and psychological suffering.
A case which is reminiscent of that of the Dentexia centers which, more than five years ago, had also hit the headlines with thousands of patients considering themselves cheated or poorly treated.
Optical costs that fly
Beyond the dental sector, the amendment is also viewed with a very good eye on the side of the Health Insurance party at war against the problems of overbilling in certain ophthalmological centers. The Cnam was notably alerted by two indicators: while the number of patients treated in these centers increased by 90% between 2015 and 2019, reimbursements were up by ... 250%. With an average cost per patient of 90 euros compared to 60 euros for a liberal ophthalmologist.
The national “task force” set up to coordinate the controls thus led to the filing of 16 criminal complaints, as revealed by our colleagues from Figaro and France 2. For a total loss of 3.6 million euros . "And a hundred centers with abnormal invoicing are monitored", we are told at the Health Insurance. Included in the infringements noted: separate invoicing of acts for the same session in order to avoid a discount, multiple invoices for the same act or even invoicing to all beneficiaries of the same insured for the same acts on the same day without consistency with their age or pathology.
“These practices cast shame on everyone, points out Dr Hélène Colombani, president of the National Federation of Health Centers, rather satisfied with the drafting of this amendment.
Our mission is to facilitate access to quality care for all audiences and some have hijacked the model of health centers.
The PLFSS and this amendment will be examined in session in the hemicycle from this Tuesday.