The amounts of fraud in the Health Insurance reached 174 million euros in 2013, up 12%. Controllers note a surge in medical transport.
Scamming Health Insurance, a national sport? For some, probably. The amounts of fraud detected in 2013 reached 174.64 million euros, according to a report from the health insurance benefits control services, quoted by Les Echos. That is an increase of 12% compared to the previous year.
Are there more frauds than before? Or are the controllers more efficient? In any case, despite its spectacular nature, this figure remains to be put into perspective. First, it is lower compared to the previous year, when the increase was even stronger (+ 17%). Then, this amount represents only a tiny part – one thousandth – of health insurance expenditure, which amounted to 173.8 billion euros in 2013.
Nurses, medical transport
Half of Medicare frauds are the work of health professionals who overcharge services, or perform “fictitious” services. According to the report, the professional categories most pinned down are nurses (18.3 million euros of fraud detected) and medical transporters (ambulance drivers, taxis), with a jump in adjustments of 38.5% in one year (at 17.6 million euros).
Added to this are the damages detected with general practitioners and specialists (6.1 million euros), dental surgeons (4.7 million euros) and physiotherapists (3 million euros). Health establishments have been caught at fault to the tune of 65.8 million euros.
Policyholders, petty fraudsters
Finally, the insured are rather reasonable compared to health professionals. Fraud involving “rights and benefits in cash” is only evaluated “at” 19.7 million euros. These include, in particular, false declarations of daily allowances in the event of sick leave or undue requests for invalidity pensions.
Health Insurance is not the only organization victim of fraud. By cumulating the adjustments made in all its branches, Social Security recorded 636.1 million euros of fraud in 2013, which breaks down into 327.3 million euros of benefit fraud (sickness, family, pensions) and 308 , 8 million euros of contribution fraud and illegal work (Urssaf).
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