Social security fraud: 13 health centers withdrawn for damage of nearly 20 million euros

The National Health Insurance Fund (CNAM) explained that this large-scale deconvention, the first of its kind, comes after the deconvention of five other centers at the beginning of the year. The centers concerned will no longer be approved from August 21, 2023. As a result, Social Security will only reimburse the care provided in these establishments on the basis of the “authority tariff”which represents refunds very weak compared to the usual prices. The CNAM criticizes the health centers of the Alliance Vision group of having invoiced fictitious acts and of having repeatedly violated the rules for the quotation and invoicing of medical acts. These discrepancies are the result of 27 complaints filed by the Primary Health Insurance Funds since June 2021, following financial damage estimated at 7.8 million euros. The Director General of Health Insurance, Thomas Fatôme, described these simultaneous cancellations of health centers in the same network as “strong signal”. Along with these administrative measures, criminal actions are also in progress against the centers of this network (source 1).

The frauds concern in particular falsely billed optical imaging and dental care. examinations intended to the elderly were carried out on children, some of whom were as young as three years old. A dental prosthesis was even charged twice for the same tooth. Social Security recalls that the situation is serious and that in-depth investigations are underway to assess the total damage, which could reach nearly 21 million euros for the entire network.