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these health professionals who fall for scams

Almost two-thirds of detected fraud is concentrated among healthcare professionals. Adobe Stock

RESEARCH – They are nurses, pharmacists, general practitioners, physiotherapists or dentists and hijack the system without scruples. Here are the techniques for this small minority.

The French are lucky: they benefit from one of the most generous social protection systems in the world. But this abundance has a flip side: it attracts all sorts of fraudsters who do not hesitate to break the law to collect unfair benefits or divert amounts to their benefits originally intended for national solidarity. Including among health professionals.

Faced with the scourge of social security fraud, Health Insurance is on the front line with its 60 million policyholders, 3 million employers and hundreds of thousands of healthcare professionals. Invoicing fictitious services or over-invoicing, impersonating healthcare professionals or insured persons to divert reimbursements, false resource statements, forging prescriptions, etc.

The profiteers of the system

The ingenuity of fraudsters, attracted by the jackpot represented by our 230 billion euros in health spending in 2021, is limitless. “Health Insurance manages a significant amount of operations: 1.4 billion treatment sheets are processed every year, 600 million euros in benefits covered per day… In terms of financial flows, we are one of the largest operators in Europe, which exposes us to all forms of fraud that we are more determined than ever to combat”, explains Marc Scholler, Deputy Director of Audit, Finance and Anti-Fraud at the National Health Insurance Fund (CNAM). Who are the system’s profiteers? How do they get on? Which healthcare professionals are most exposed to fraud? What is the value of the damage that society has suffered?

In particular, we have taken as a starting point the work that Sygesikringen has carried out in recent months to try to assess the extent of the fraud. We are surprised to discover that, contrary to what people think, …

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