Health insurance fraud: in Ile-de-France, two disappointed health centers

The decision to notify care is taken for a period of five years without suspended. This is a first, according to health insurance. The Trappes Center (Yvelines) offers dental care, that of Blanc-Mesnil (Seine-Saint-Denis), dental care and acts of ophthalmology.

by Mattea Battaglia

Patients will always be able to go there, but they will no longer be reimbursed – or on a very low basis of 1 euro and dust, for a specialist consultation invoiced 30 euros. Two dental and/or ophthalmological health centers, one located in Trappes (Yvelines), the other in Blanche-Mesnil (Seine-Saint-Denis), were thawed by health insurance for “fraudulent practices” whose damage amounts to nearly 1.5 million euros, said the latter on Sunday 22 January.

The first offers dental care only, the second adds acts of ophthalmology. This decontentation decision -a first, said the organization -taken for a period of five years suspended, was to take effect on Monday January 23 for the center of Seine -Saint -Denis, the 1 SUP> February for that of the Yvelines. It was decided with the favorable opinion of the members of the departmental joint commissions.

The recent opening of these two centers -one in 2021, the other in 2022 -, in territories which, as elsewhere in Ile -de -France, do not escape medical desertification, had been welcomed by the inhabitants. It is from them that the white-mesnil alerts came, reports Le Parisien, who revealed the two cases: compulsory COVVID tests, prescriptions offered to the guides, double billing … Over the months, patients have opened up These abuses.

In Trappes, the internal survey conducted by the Yvelines primary health insurance fund and quoted by Le Parisien estimated the prejudice to 1 million euros, for nine months of activity. “In particular, these centers have been criticized for having established false invoices and of having billed fictitious acts, that is to say not carried out,” said health insurance. In both cases, the two primary funds concerned filed a complaint.

very serious drifts

Dental and ophthalmological centers, the development of which has been favored to improve the supply of care, especially in areas where medical demography is not enough to meet needs, are in the crosshairs of many medical and paramedical professionals. In the fall of 2022, health insurance communicated on a “strengthened strategy” of antifraude struggle. Backed strategy on new legislative levers, in the social security financing law of 2022 as in that of 2023.

The National Assembly voted at first reading, on November 30, a bill brought by the deputy Fadila Khattabi (Renaissance, Côte-d’Or) in favor of a stricter supervision of these centers, and in particular of a prior approval of regional health agencies for those who provide dental or ophthalmological care. With, in the background, the memory of the dentexia and proxidental scandals which, in 2015 and 2021, highlighted very serious drifts. The text must be examined in the Senate in mid-February.

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/Media reports cited above.