A scam has been uncovered in France involving ophthalmology centres (centres ophtalmologiques) routinely claiming back too much money for routine eye testing.
It is estimated to have caused the Sécurité Sociale losses of €3.6million since October 2020, although there has been no cost to patients as it is covered by patients’ health insurance providers rather than payment being taken upfront.
Criminal complaints relating to fraud, forgery and false declarations were filed against 12 centres over the summer, it was reported in Le Figaro.
An investigation by the French news programme L'Œil du 20 Heures has now revealed that the Sécurité Sociale is preparing to file at least four more.
Ophthalmology centres have proliferated
The number of ophthalmology centres in France has increased rapidly in the past three years, since the regulations governing the setting up of health centres were relaxed.
There are now in the region of 150 of these centres, and as appointments can be secured without booking, the number of tests being carried out has also increased exponentially.
Eye care costs on the up
However, the French health insurance system has also noticed a sharp rise in the costs associated with the type of routine eye care provided by these establishments.
The average amount charged for an appointment at one of these centres in 2020 was €96.50 per patient with some of them averaging over €150.
By comparison, private ophthalmology practices were charging an average of €63.50 per patient.
"This is routine, entry-level healthcare, and there is no explanation for these differences in costs," said Catherine Bismuth, a doctor and in charge of detecting fraud at the Assurance maladie, to L'Œil du 20 Heures.
She said there were several common invoicing irregularities suggestive of fraudulent practices, including one that saw clinics charging for an entire family, but having in reality only seen one family member.
Another involves billing for follow-up procedures, despite the patient having never returned.
Have you been to see an ophthalmologist? You can help fight the fraud
To help the Sécurité Sociale crack down on this problem, the agency is asking patients to report any anomalies they notice in the online payment system to their health insurer.
Because invoices are submitted to Sécurité Sociale and to insurance companies automatically, without the patient having to pay for them out of pocket, irregularities can often go unnoticed.
You can check to see what you were charged for your appointment by logging into your account on France’s national health insurance website Ameli.
What is an Ameli account?
An Ameli account is a secure online personal area from which you can access various services related to your health insurance.
It can be used to check on the status of any reimbursements, download certificates, contact an advisor, modify your personal information, etc.
You’ll need to provide the social security number on your Carte Vitale and bank details (RIB) when you register.
If you are already registered for the service, you should have received a letter or an email confirming it.
Social Security recommends that everyone consult the statements in their personal account regularly, to check that they tally with the care received.
Ameli also gives me the option to sign in with a France Connect account. What is this?
FranceConnect is a single user ID code and password combination that enables you to sign in to hundreds of services in France.
This includes the impots.gouv.fr (tax website); ameli.fr (site for Cpam health authorities); Mobile Connect et Moi (for Orange mobile customers – to be expanded later to other firms); MSA (farmers’ social security); alicem (an Interior Ministry app); or La Poste’s identité numérique.
FranceConnect is linked to these because they all check a person’s identity carefully as part of registration.
There is therefore currently no way to use the service if you are a non-French non-resident with no declarable French income.
Opticians and ophthalmologists in France - what’s the difference?
In France, the optician is where you go to buy glasses, but you get your eyes tested first by going to see an ophthalmologist (ophtalmologue). They then issue the prescription that you take to the optician.
Your GP can recommend a reputable ophthalmologist.