Nearly 200 million euros: this is the amount of Health Insurance fraud for the year 2014 alone noted by the economic newspaper The echoes. This amount is a record, and corresponds to an increase of 17% compared to 2013: “the total amount of fraud and wrongdoing detected […] amounted precisely to 196.2 million, compared to 167.1 million in 2013“says the daily.
First fraudsters: health professionals
Of the 196 million euros, 73 million (or 37%) were diverted by doctors. In practice, this fraud most often manifests itself through fictitious home visit invoices, for which the doctor himself fills in and signs the care sheets instead of the insured. In second place: health establishments which totaled 52.6 million euros, i.e. 27% of the total amount in “coding acts in a tendentious, even misleading way“, according to the Echoes.
At the same time, the policyholders themselves participate in 20% of fraud, with 38.8 million euros. The most common techniques would be unjustified benefits of universal health coverage (CMU) or long-term illness cover (ALD) covering 100% of medical procedures.
Finally, medical transport contributes to these frauds for nearly 22 million euros, by using counter traffic or false declarations of patients in ALD.
About 1% of healthcare costs
The amount of these frauds remains low compared to the 178 billion euros of health expenditure recorded for the year 2014: fraud thus represents 1.1% of health costs. Over the past ten years, the repression of such acts has enabled the Health Insurance to recover 1.4 billion euros. During this same period,2,900 bans on providing care were pronounced by the orders against health professionals who cheated, and 2,600 fraudsters were sentenced to prison“explains Les Echos again.
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