Social security fraud in France hit a record €315 million in 2022, the Assurance maladie director general has warned, a 44% increase compared to 2021.
The Assurance maladie announced the figure in a statement on March 9. The €315million figure marks the fraud that the agency managed to detect and stop.
It represents 44% more fraud compared to 2021 (€219.3million), and 10% more compared to 2019, which was, until now, the highest amount ever recorded, the statement said, at €286.8million.
In an interview with FranceInfo, director general Thomas Fatôme said most of the fraud comes from health professionals filing the claims. The issue is particularly apparent among dental professionals and ophthalmologists, he said.
The record figure was calculated through the increased “use of detection, checking, and sanctions”, Mr Fatôme said. “We are facing, unfortunately, a certain number of dental clinics and ophthalmologists who do not respect the rules, or what we call the ‘nomenclature’ of work.
“This is like charging for the equivalent of a new filling when a simple tooth cleaning has been done.
“We are unfortunately seeing a wide range of fraud across a certain number of centres.”
Around 50 dental centres and more than 30 ophthalmologist offices are currently under investigation. The director general said: “Our investigators will look at every file, to see exactly what’s happening.”
He added that many pharmacies had also “gone far into fraud” during the pandemic, to an estimated €60 million overall, with around 60 pharmacies investigated and charged.
Some of the fraud investigations come from patients, who flag up when their records do not match the treatment that they received. Patients are encouraged to contact the Assurance maladie if they “notice anything strange”, said Mr Fatôme.
“Some contact us through their Caisse’s phone number, on 36 or 46, or by letter.”
Most cases are flagged by the Assurance maladie, using ‘big data’ to identify and check anomalies. The agency has more than 1,600 fraud specialist agents, as well as computer technology designed for the purpose, to identify any possible issues.
If a centre is found to be engaging in fraudulent activity, the Assurance maladie quickly ‘delists’ them from its system, and stops any payments suspected of being fraudulent as soon as possible. It may also move to issuing fines, or even penal sanctions.
Of the 8,817 actions taken in 2022, almost two-thirds ended with penal sanctions, and financial penalties, the statement said.
The Assurance maladie works to first prevent fraud, then to detect it by analysing data, then to check it, and then, if found, to move to sanctions.
Mr Fatôme said: “We don’t hesitate to go down the [criminal proceedings] route. We also have fines at our disposal. We can also remove the professionals’ licence to practice if we find that [the fraud] is their responsibility.”
However, Mr Fatôme did say that “the immense majority of insured people and professionals do play by the rules”, and that the €315million of fraud was still relatively low compared to the service’s €230 billion total budget.