A GP from Marseille was arrested after falsifying the prescriptions and certificates of her colleagues to prescribe sick leave and defraud the CPAM, while continuing to practice in her office.
Incredible story: a general practitioner installed in the northern districts of Marseille, has been taking sick leave since 2011 by falsifying the prescriptions and certificates of his colleagues. For 8 years, she pocketed the benefits of the Primary Health Insurance Fund (CPAM) and the complement of her mutual, while continuing to work in her office.
It was ultimately the doctor to whom the prescription clerk belonged who discovered the pot of roses. The Bouches-du-Rhône Departmental Security arrested the general practitioner, who will now have to answer for her actions in court. According to France Blue Provencewhich reports the facts, the amount of the fraud would amount to €820,000.
Enrichment through health insurance fraud
This health insurance fraud is far from an isolated occurrence. In 2018, for example, thehe Social Security of Indre-et-Loire uncovered fraud worth €815,000 in 2017, half of which was attributable to healthcare professionals who invoiced fictitious procedures or over-invoiced others. By way of comparison, fraud by policyholders represented €260,000 and that by healthcare establishments €114,000.
Last October, three doctors and two physiotherapists from the Rennes region were arrested and placed in police custody. Social security had indeed noticed that a large number of requests for reimbursement of care had been prescribed by the same doctors and carried out by the same physiotherapists. According to West France, these were again fictitious acts. The amount of damage would be €300,000.
In Deux-Sèvre, after two years of investigation, a pharmacist suspected of having defrauded €468,000 from the CPAM between 2012 and 2018 was heard by the courts, according to France Blue Poitou. She had a habit of forging prescriptions and getting reimbursed for cancer treatments, some boxes of which can cost €5,000.
Another pharmacist, based in the Landes this time, appeared before the Dax court on December 9 after defrauding several health insurance organizations of €740,000, reports The Dispatch. The court sentenced her to two years in prison, one of which is firm (a penalty that can be adjusted), and to pay a fine of €343,838 for the benefit of the CPAM des Landes, the MSA, the national military social security fund and the Security of self-employed workers in Aquitaine.
261.2 million euros defrauded from the CPAM in 2018
According to a balance sheet of the CPAMhealth insurance fraud reached 261.2 million euros in 2018, of which three-quarters (ie 130 million euros) are attributable to professionals and healthcare establishments. In detail, 47% of this amount is due to professional fraud and 30% to establishments. “Nearly 23,000 investigations and 8,500 litigation actions have been initiated, specifies the CPAM. Since 2005, nearly 2.4 billion euros of detected fraud have been stopped and sanctioned.”
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