Home Insurance 80% is carried out by professionals, points out the Court of Auditors, which regrets the lack of control

80% is carried out by professionals, points out the Court of Auditors, which regrets the lack of control

80% is carried out by professionals, points out the Court of Auditors, which regrets the lack of control

In its annual report on social security, the Court of Auditors estimates fraud with social benefits at between 6 and 8 billion per year. It recommends targeting controls and improving collection.

The government is drawing up a plan to combat social security fraud. These measures will accompany the anti-tax evasion plan. And a figure can enlighten the executive: the Court of Auditors estimates that fraud with social benefits amounts to between 6 and 8 billion euros. An estimate given on Wednesday, May 24 in the annual report on the financing of social security. Half of these scams relate to health insurance.

Out of this range of 6 to 8 billion euros per year, health insurance fraud accounts for around 4 billion euros. Of this proportion, the vast majority, 80%, comes from professionals. A few examples: doctors are compensated for fictitious actions that were never performed; nurses declare actions incompatible with each other. The Court of Auditors also mentions individual physiotherapists or paramedics. And we are talking about fraud and not errors. The other part of the assortment, apart from these health expenses, comes from the beneficiaries, the beneficiaries. With fraud, for example on the RSA or the activity bonus.

“Targeted controls” which require “some political courage”

In any case, Pierre Moscovici, the President of the Court of Auditors, calls for a real strengthening of the control, which is very inadequate. “The health insurance checks only 1 to 4% of the invoices issued by the various professions. No check has been made since the health crisis on the bills of the health institutes. No. on the spot than 3% of the 3.1 million households that benefit RSA. And so we very clearly need to change scale, change speed. There are two things that need to be done. First, we need to increase the means of control. And then second, those controls need to be better targeted. And all of that requires some political courage .” Regarding the funds, Pierre Moscovici points to the number of agents responsible for these controls: 3,400, where more are needed, according to the Court of Auditors.

The judges of the Court of Auditors also provide an opportunity to facilitate this control. In addition to the workforce, they provide technical recommendations to target and identify these frauds upstream. Actually prevent them. For example, computer systems should be improved against fraud committed by healthcare professionals. Updates will make it possible to block, for example, invoices for inconsistent actions. Regarding the family branch, the Court proposes to revise the application methods: the funds will not only depend on the income declared by the beneficiaries themselves, but they can receive data from third parties, e.g. Pôle emploi or employers.

And one of the issues is the recovery of amounts paid to fraudsters. How to recover this money and get it back to the state coffers? So far, the system is ineffective. According to the Court of Auditors, only 1 to 10% of the amounts are recovered. And again, it’s all about targeting. The actions cannot be the same for professionals and for beneficiaries, according to Véronique Hamayon, president of the Chamber of the Court of Auditors responsible for the annual report. “When it comes to healthcare professionals, we may have a few large fraudsters, then a relatively small number of fraudsters for large amounts. Whereas when it comes to individuals, patients or social security recipients of “various benefits, it is the opposite. We have a very large number of recipients for individual defrauded amounts which are relatively small. So we have to do many, many checks to be able to recover defrauded amounts.”

Finally, the Court of Auditors recommends additional sanctions for all these fraudsters of social benefits.


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