Patient reimbursement to end at French dental centres amid fraud claim

Irregularities noted at 10 sites include false invoices for crowns, invoices submitted twice and procedures carried out despite being deemed unnecessary

The suspected fraud is said to include dental procedures deemed unnecessary but carried out anyway (photo for illustration only; does not show a Nobel Santé + clinic)

Ten dental centres across France are to lose the right for their patients to receive health insurance reimbursement for treatments on suspicion of fraud to the tune of €2.9 million.

From May 13, the centres, which belong to the Nobel Santé + network, will be ‘decertified’ after irregularities were detected that, it is claimed, relate to fraudulent practices.

The centres are located in four regions of France: Île-de-France, Provence-Alpes-Côte d'Azur, Auvergne-Rhône-Alpes and Nouvelle Aquitaine. Overall, the network has 26 centres nationwide.

They have been monitored by around 50 investigators over the past two years. Irregularities noted include false invoices for crowns and other dental repair work, invoices submitted twice, and procedures deemed unnecessary but carried out anyway.

The investigation began after La Caisse primaire d'assurance maladie (Cpam) in Essonne made the first complaint at the start of 2020. In total, 10 complaints would be made over the course of the investigation, which was also partly coordinated by the l'Office central de lutte contre le travail illégal (OCLCTI).

The group’s headquarters in Paris were raided in mid-January, and the bank accounts blocked.

The estimated loss is €2.9 million.

Reimbursement stopped

‘Decertifying’ the centres means that patients who visit them will no longer be reimbursed for treatment - or will only receive very small sums (less than €1 per consultation). The sanctions will last between one and five years, depending on the centre.

The Assurance maladie is now attempting to recover the funds, and has lodged criminal complaints against the centres. All patients who have visited the centres will also be informed of the fraud (although they themselves will not be liable for anything).

‘Strategy against health insurance fraud’

"This new wave of decertifications is part of a strategy to step up the fight against health insurance fraud,” said Thomas Fatôme, managing director of the Assurance maladie, to FranceInter.

"We can see that in these health centres, there are clearly a number of managers who are not there primarily to care for patients, but to organise fraudulent practices in a fairly systematic way…Unfortunately, we found this, in this case, in these 10 or so health centres.

“The message we are sending to the centres, and the message I want to send to all policyholders, is that, in the end, Assurance maladie funding will no longer be used to finance the fraudulent practices of these health centres,” Mr Fatôme said.