A rare decision.
Two dental or ophthalmological health centers in Île-de-France have been 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.
According to the newspaper
Le Parisien
, the centers are located precisely in the towns of Trappes (Yvelines) and Blanc-Mesnil (Seine-Saint-Denis).
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“
These centers are notably accused of having established false invoicing and of having invoiced fictitious acts, that is to say not carried out
”, specifies the National Health Insurance Fund (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.
This deconvention “
is a first in France concerning a health center
”, indicated to the
Parisian
the National health insurance fund (Cnam).
Health insurance checks
Concretely, this means that Social Security will only pay for care there on a very low basis, the so
-called “authority
” tariff.
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 which have been detected there
”, it indicates in its press release.
Complaints of fraud have also been filed, according to
Le Parisien
.
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, Health Insurance says it is “
strongly mobilized
” in the control of centers which display “
atypical
” billings.
It specifies that “
88 dental health centers and 44 ophthalmological health centers are currently subject to checks by the health insurance funds
”.
