Culture

investigation of social security fraud professionals

Automatic panoramic dental X-ray, race to fit prostheses, useless or even fictitious care. Dental centers with state-of-the-art equipment, which have multiplied in urban areas (+ 60% in five years), are charging with a vengeance. Six years after the scandal of the mutilated patients of the Dentexia low-cost centers, it turns out that these structures are still very lucrative, and not always scrupulous.

The receipts of one of them, stemming largely from Social Security reimbursements, even pass through two companies domiciled in low-tax countries. This is one of the deviations raised by this edifying issue of “Cash investigation”, centered on health insurance fraud by health professionals.

End of automatic checks

In its 2021 report, health insurance noted that 27% of the amount of fraud detected was the fault of the insured, against 72% that of health professionals. On the arrival peloton, the liberal doctors (245 million euros of fraud) come in third position behind the physiotherapists (306 million euros) and the liberal nurses (1 billion euros).

Over the course of long months of investigation, the journalist Donatien Lemaître has multiplied the testimonies of patients and repentant professionals. Retirement homes in the south of France are proving to be an El Dorado for some nurses, billing Social Security for daily care that is sometimes uninsured or imaginary.

The minister promises “reinforced controls”

How are such practices possible? To explain it, “Cash investigation” deciphers from the inside the functioning of Social Security since the generalization of third-party payment at the end of 2017. The liberal doctors having obtained in return “payment guarantee” care, the State services reimburse within seven days by carrying out only a posteriori and random check.

Questioned by Élise Lucet, the Minister of Health François Braun promises controls “strengthened and improved»but defends the principle of “the guarantee of payment”.

Source : BBN NEWS

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