Health insurance is on a crusade against prescription and billing abuse. Recently, she announced that she would stop reimbursing sick leave prescribed in video.
In parallel, she is interested in eye centers accused of invoicing fictitious acts, prescribing useless assessments, diverting the delegation of tasks to orthoptists, according to information revealed by the JDD.
In total, 26 criminal complaints were filed against these ophthalmology centers for “fraud, forgery and use of forgery” according to the JDD. The Paris prosecutor’s office, which is coordinating this vast financial investigation, carried out searches at the end of 2021. Thierry Bour, the president of the National Union of Ophthalmologists of France, has just filed a complaint against X on behalf of his organization.
Not less than twelve eye centers, located in Ile-de-France, Provence-Alpes-Côte d’Azur, Normandy, Hauts-de-France, Pays-de-la-Loire, Auvergne-Rhône-Alpes, Centre-Val-de-Loire and Grand Est are in the sights of health insurance. The latter considers that non-compliant invoicing practices have been carried out: redundant acts, double invoicing, invoiced acts that have not been carried out, etc. “Some of the centers are functioning normally but we have the impression that they are becoming a minority and that we are witnessing a generalization of excesses”which undermines the credibility of the profession, still denounces to AFP, Doctor Bour.
THE total of this scam? around 7 million euros. “Some people sometimes schedule six appointments for a simple change of glasses. We are victims of looting”, declares a health officer to the JDD.
Dramatic cost increase
Health insurance is concerned to see these fraudulent actions becoming widespread in ophthalmological centers. In this case, the targeted centers are spread all over France, but belong to the same group.
According to information from AFP, the ophthalmological centers which accumulate patients (more than 500) have multiplied. They were 88 in France in 2015, against 157 in 2020, estimates the Cnam. Costs have also jumped, around 50% per patient. Between 2015 and 2019, the costs and expenses of these centers increased from 20 million euros to 69 million euros, an increase of 250%.
Sources: AFP, JDD
