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Complementary solidarity health, liberal nurses: the heavy bill of Social Security fraud

Since the end of 2020, Health Insurance, pressed by the Court of Auditors and Parliament, has undertaken a vast investigation to try to quantify the amount of fraud of which it is the victim. Initial conclusions were presented, Wednesday, May 11 in the Senate, and relayed this Thursday by The Parisian. Two components were scrutinized: complementary solidarity health (C2S) and liberal nurses.

And the finding is clear: the fraud amounts to several tens of millions of euros. For liberal nurses, Health Insurance analyzed their 2018 billing data. Result: the fraud is estimated between 286 million euros and 393 million euros while social security reimbursed a total of 5.7 billion euros. euros that year. Fraud is mainly linked to non-compliance with the billing nomenclature as well as fictitious or multiple billings, reports the Ile-de-France daily.

Regarding the second component studied, complementary health insurance (C2S), Health Insurance estimates the damage at 176.5 million euros. To arrive at this figure, the organization drew lots from 10,000 files and found that 8.7% of the beneficiaries exceeded the resource ceilings. In 1.22% of cases, income was even three times higher than the ceiling.

The weapons to fight these frauds

To combat these frauds, Health Insurance has implemented several weapons. For self-employed nurses, support was reinforced during their installation, with two educational checks during their first year of activity. In addition, a new “datamining” tool should make it possible to better analyze their activity, but also to target files at risk. Since January, a monthly resource system (DRM) has also been put in place. It makes it possible to automatically request the income of beneficiaries from organizations and companies. “With the DRM, fraud on the declaration of wages will no longer be possible”, assures the Health Insurance with the Parisian.

By the end of the year, the works concerning the frauds of general practitioners, physiotherapists, or even pharmacists should be published. In 2023, it will be the turn of dentists, specialists and biologists.

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