these health professionals who fall into fraud

Nearly two-thirds of detected fraud is concentrated among healthcare professionals. Adobe Stock

INVESTIGATION – They are nurses, pharmacists, general practitioners, physiotherapists or dentists and hijack the system without scruple. Here are the techniques of this tiny minority.

The French are lucky: they benefit from one of the most generous social protection systems in the world. But this abundance has a downside: it attracts all sorts of fraudsters who do not hesitate to break the law in order to collect undue benefits or divert for their benefit sums initially intended for national solidarity. Including among health professionals.

Faced with the scourge of social fraud, Health Insurance is on the front line, with its 60 million policyholders, 3 million employers and hundreds of thousands of health professionals. Invoicing of fictitious services or over-invoicing, impersonation of health professionals or insured persons to divert reimbursements, false declarations of resources, falsification of prescriptions, etc.

The profiteers of the system

The inventiveness of fraudsters, attracted by the jackpot represented by our 230 billion euros in health spending in 2021, is limitless. “Health Insurance manages a considerable volume of operations: 1.4 billion treatment sheets processed each year, 600 million euros in services covered per day… In terms of financial flows, we are one of the most large operators in Europe, which exposes us to all kinds of fraud against which we are more determined than ever to fight”, explains Marc Scholler, deputy director of audit, finance and the fight against fraud at the National Health Insurance Fund (CNAM). Who are the profiteers of the system? How do they proceed? Which healthcare professionals are most exposed to fraud? What is the value of the harm suffered by the community?

We based ourselves in particular on the work carried out over the past few months by the Health Insurance to try to assess the extent of the fraud. We discover with surprise that, contrary to popular belief, the…

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