Medicare : fraud has amounted to nearly 300 million euro in 2019 - The Point

health Insurance remains a victim of fraud huge. In 2019, she has reached not less than 287 million euros, according to the figures identified by the director o

Medicare : fraud has amounted to nearly 300 million euro in 2019 - The Point

health Insurance remains a victim of fraud huge. In 2019, she has reached not less than 287 million euros, according to the figures identified by the director of the Caisse nationale d'assurance maladie (Cnam) before the commission of inquiry of the national Assembly on the fraud to social benefits, and which The Parisian echoes Thursday. "The monitoring devices have enabled us to avoid the payment of 200 million euros ", has also noted Nicolas Revel. A fraud that does not come particularly to an abuse of a card Vital, but more of " providers of care ".

In total, approximately 1 650 field agents have worked on some 13 million of invoices. "23 000 investigations have been opened following damage and 8,800 shares in dispute were open, compared to 5 500 in 2014 ", has detailed the boss of the Cnam. Alone, the fraud operated by professionals and health facilities represents 20 % of the cases, but 48 % of the total financial damage, with not less than 135.1 million euros.

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The "organized groups" of fraudsters

In detail, the fraudsters are, to 48 %, of health professionals such as pharmacists, doctors, or even carriers, while 31 % were healthcare institutions, says the daily. In 51% of cases, the fraud is committed by the insured, but the amount remains much lower because it only accounts for 21 % of the total loss sustained by the Cnam.

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Worse, the investigators of the Cnam are able to identify real "organized groups" who are most often their business online. They propose particular fake work stoppages or charge medications to the Cnam, which will be ultimately made available on the markets of other countries ' health. The $ 287 million of fraud established and could translate only part of the iceberg. "Encrypt the fraud is impossible, its magnitude appears to be as we discover it," explained Nicolas Revel in always relayed by Le Parisien.

fraud in the card not-so-high

However, it would seem that the fraud on the card may be less important than expected. According to the boss of the Cnam, at the end of last year, " there was in France 58.4 million cards Vital outstanding of 59 million people over the age of 16. The question cards Vital is not a marker of fraud ", he says then only an estimate, before the same commission of the Palais-Bourbon, moved in last February that the surplus of cards Vital in circulation reached 2.6 million.

Updated Date: 18 June 2020, 02:33

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