A pharmacy in Haute-Garonne is suspected of having falsified prescriptions since 2015. The damage would amount to 30,000 euros, according to the estimates of the Primary Fund.
In 2015, the Health Insurance detected and stopped fraud amounting to 231 million euros, an increase of 18% compared to 2014. It is therefore not surprising that a new case of this kind shakes up the news on Tuesday.
The story takes place this time in Haute-Garonne where a pharmacy is suspected by the Primary Health Insurance Fund (CPAM) of having falsified prescriptions in 2015.
30,000 euros in damages
La Dépêche du Midi, who revealed the case, explains the subterfuge. The dispensary sent prescriptions to the department’s CPAM to unduly obtain reimbursement for undelivered drugs. This parade also had the advantage of ensuring that the pharmacist had well-filled stocks.
Alerted by patients worried about seeing a difference between their prescription and reimbursements revised upwards, the controllers of the CPAM of Haute-Garonne conducted the investigation.
“We studied the files from this pharmacy over a given period. It was necessary to call all the insured to ask them if they had indeed the delivery of all the prescribed drugs ”, detailed in the daily Isabelle Tartarin, deputy director of the CPAM in charge of the direction of health. The damage would, for the moment, be estimated at around 30,000 euros.
The classification of fraudsters by the CNAM
“To calculate the damage, we can start from research over a given period and we extrapolate: if he has made such an amount over six months, we will assume that over a year or a year and a half, the damage amounts to so much. », Explained Isabelle Tarartin.
“It’s complicated for the Health Insurance to spot this type of fraud because the drugs had been prescribed”, concluded Isabelle Tartarin.
In its last report, the Health Insurance relayed that the largest contingent of fraudsters to Health Insurance, among professionals, is among nurses (55%). They are followed by suppliers (23%), pharmacists (7%), physiotherapists (5%) and health transporters (4%).
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