ophthalmologists are in the crosshairs of the national health insurance Fund. According to several sources-Agence France-Presse, confirming information of the Parisian, of the "abnormal operation", and "abuse" amounting to fraud were recorded in health centers of ophthalmology, institutions, born of a relaxation of legislation from 2018. According to the national College professional ophthalmology (CNPO), the new name of the French Academy of ophthalmology, these "acts somewhat justified" and these "strategies of billings highly critical" have been identified by "different sources" these last few months. "Controls have been incurred by the national health insurance Fund, which has also identified these deviations, whereas there is a rapid increase in the number of these centres," assured the CNPO in a press release.
According to Le Parisien, which had access to an internal report of the health Insurance (Cnam), it is the surge in refunds claimed by these health centres of a new kind, in full swing since 2018, which would have raised suspicions. "For a patientèle increased from 400 000 in 2015 to 800,000 in 2019 (+ 100 %), the cost of repayments rose by 245 %, to meet" the 69 million euros, " stresses the report, quoted by the daily. When questioned, the Insurance did not respond Monday to the requests of the Agency France-Presse.
drift "detrimental to the specialty"
According to the Syndicat national des ophtalmologistes de France (Snof), several " abusive practices ", would be at the origin of this increase, as "the billing of multiple acts orthoptiques and medical" and " comprehensive examinations systematized seemingly little relevance ". "These results shed light on a phenomenon that is latent and ignored until then, payers, namely a drift in tariff important [...] detrimental to the specialty," insists in a press release the Snof, hostile to the development of these health centers eye.
The health centres, the development of which is fostered by the importance of deadlines for obtaining an appointment with an ophthalmologist liberal, are fixed in sector 1, so forbidden overtaking fees. They are available sometimes in less than 24 hours. In his statement, the CNPO warns his side against any "amalgam," including " with the health centres of historical, non-profit, designed on a mutual model and traditionally managed by the communities and territorial institutions ". "The medical community eye made a call to vigilance, and relies on the ethics and meaning of ethics of each professionals," insisted the Council.
Read also When pharmaceutical companies court the force