Last week, we told you about a dental surgeon practicing in Hauts-de-Seine who had, between 2009 and 2013, defrauded more than 2 million euros from Social Security. This time, the case is happening in Toulouse (Haute-Garonne): a general practitioner was placed in police custody on Tuesday, July 11, 2017 for a Social Security fraud estimated at € 420,000.
Aged 45, the doctor had mounted a very lucrative scam: he declared patients non-existent and collected the payments for his consultations by sending the bill directly to the Caisse Primaire d’Assurance Maladie (CPAM) in Toulouse. Profit: € 420,000 between January 2013 and March 2016.
It was precisely the concerned CPAM who seized the Toulouse public prosecutor’s office: by monitoring the doctor’s (abnormally bubbling) activity, investigators from the brigade for the repression of astute delinquency (BRDA) realized that he was declaring sometimes up to 115 patients per day.
Very (very) quick consultations
Obviously, mathematically, it did not fit: 50% of the fraudulent doctor’s appointments were sent in less than 5 minutes and 15% in less than a minute … while on average, in France, the consultation with a general practitioner lasts 16 minutes.
The system was well established: the general practitioner took care to use the data of patients benefiting from universal medical coverage (CMU). These do not have to pay the GP at the end of the consultation since he is directly reimbursed by the CPAM. If possible, he added additional costs, related to night consultations …
If the doctor’s secretary was also placed in police custody on July 11, 2017, she was quickly released. The patients, them, fell from the clouds: according to the figures, some had consulted their general practitioner more than 100 times in a few months … History to follow!
Read also :
Health insurance fraud on the rise in Alsace
Social security scam: the fraudulent dentist receives two years in prison
