Published on
Updated
Reading 2 mins.
Two health centers offering dental or ophthalmological care have just been deconventioned by Social Security. In question: “fraudulent practices” whose amount amounts to 1.5 million euros, according to the National Health Insurance Fund (CNAM).
1.5 million euros! This is the damage suffered by Health Insurance, victim of the abuse of two health centers offering dental or ophthalmological care in Ile-de-France, more precisely in Yvelines and Seine-Saint-Denis.
Cancellation due to “fraudulent practices”
These two health centers, located in Trappes and Blanc-Mesnil, are accused “to have established false invoicing and to have invoiced fictitious acts, that is to say not carried out“said the National Health Insurance Fund in a press release.
“In view of the seriousness of the facts and the amount of the financial damage“rated at”nearly 1.5 million euros for these two centers“, Health Insurance has decided to cancel them “for a period of five years without suspension”. These decisions have been notified and will take effect on January 23, 2023 for the center of Seine-Saint-Denis and on February 1, 2023 for that of the Yvelines.
Very weak support
Following this decision, Health Insurance will only cover the care provided in this center “on a very low basis, the authority rate, i.e. for an ophthalmology consultation at €30, for example, a reimbursement of €1.22“.
She “therefore strongly advises its policyholders not to use these centers, a fortiori in view of the fraudulent practices that have been detected there” and reminds that “health centers have an obligation to inform patients of their rates and the conditions for reimbursement and exemption from advance payment”.
Low fares in sector 1
When questioned, Dr. François Pelen, co-founder of the Point Vision centers, recalls first of all that there are two types of centers: liberal centers, such as the Point Vision centers, for example, and the health centers involved here , who practice “social medicine”.
For him, this type of infrastructure which operates in sector 1, with fairly low tariffs, sometimes has financial difficulties because of the quotation tariffs which have not been reviewed for years. “I’m not condoning these frauds, of course, but it’s important to point out the context. We also have centers that operate in sector 1 and it’s not easy every day” he indicates.
Towards more frequent checks?
Moreover, the doctor denounces these actions because “they damage the image of all the professionals who work there, unfortunately” while he “there are very useful health centers, which work honestly“he rightly recalls.
According to him, “this type of checks will probably increase in the years to come, with investigations in the premises of this type of center, in order to verify the veracity and usefulness of the examinations carried out”. In its press release, the CNAM estimates that “88 dental health centers and 44 ophthalmological health centers are currently subject to checks by the health insurance funds” and is likely to further strengthen its controls in the years to come.