In 4 years, this Gironde couple has billed 10,000 acts which have, in reality, never been performed. The protagonists risk an exercise ban and a fine.
Overcharged acts or trips, fictitious care… For 4 years, a couple of nurses from Gironde defrauded the Primary Health Insurance Fund (CPAM) of Gironde and two other organizations. The fraud would amount to 950,000 euros. They were tried by the Bordeaux Criminal Court on Monday, July 3.
The prosecution requested a one-year suspended sentence and a fine of 20,000 euros against the nurse. His wife risks, for her part, 6 months suspended prison sentence and 5,000 euros fine. The couple could also be sentenced to a 5-year ban on practice. The case was taken under advisement as of September 18.
They are appearing for “fraud for having overcharged nursing acts, invoiced for acts they would not have done, overcharged acts, carried out fictitious acts and overcharged travel costs for patients”, described to AFP their lawyer Henri-Michel Gata.
A monthly salary of 40,000 euros
During the investigations, the investigators noted numerous irregularities. In view of the number of acts invoiced, they notably estimated that nurses had to work an average of 20 hours per day 366 days per year to pocket as many agents. They also noted that 10,000 acts billed through third-party payment were never performed. Thanks to these different sleight of hand, the couple would have received up to 40,000 euros per month, according to the newspaper South West.
For their lawyer, the couple are not the only culprits. He explains, in fact, that the system is not very clear and favors this kind of situation. “We are more on difficulties in understanding the nomenclature of the CPAM, which can be very vague and subject to interpretation by nurses, than on a real desire for fraud. It is culpable negligence, there have been approximations, ”he said.
In any case, the National Council of the Order of Nurses sees things differently. In 2016, the nurse was sentenced to a 24-month ban on practice. He would have entrusted his patient to his wife.
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