It will dissuade fraudsters.
628 million euros. This is the sum of money represented by health insurance fraud in 2024. Among them, the number of false sick leaves particularly climbed last year and represents financial damage of 42 million euros. To thwart fraudsters, surveillance and controls have been intensified, Health Insurance announced in a press release on March 20.
This year again, health insurance checks work stoppages, crossing information from insured people with those of employers. This monitoring makes it possible to identify anomalies or inconsistencies in the declarations of the judgments. It also performs unexpected medical checks during which controller doctors go to insured people to verify that their health statement corresponds well to the prescribed work stoppage. It uses sophisticated IT tools to detect “risk profiles”, especially those with repeated or abnormally long stops. These measures, made upstream of the payments of work stoppages, aim to guarantee that daily allowances are only allocated to people actually on sick leave.
In addition, a new workout authentication system is set up this year: secure cerfa. Concretely, this is an official document that can be difficult to falsify because it has reinforced safety characteristics (special paper, barcodes, holograms, magnetic ink, band that changes color in the event of photocopy, unique tracking number …). Stop information, such as duration and medical reasons, can thus be better controlled, recorded and linked to a precise and verifiable identity. It will be compulsory from June 2025 for paper shipments and only this form may be accepted by health insurance to claim daily allowances. Practitioners are strongly encouraged to use them now.
The fraudsters use different techniques to perceive daily allowances in an illegal way: by creating “false” work stoppages using accomplices or falsifying documents; by extending their stop when they are in good health; By continuing to work during the judgment, thus taking advantage of the compensation while having an undeclared parallel income; Or by pretending to be sick when they are not. These frauds can, in certain situations, prejudice the prescribing health professional whose identity has been usurped. In the event of proven fraud, sanctions can be applied: health insurance can recover the compensation paid wrongly and, in some cases, penal penalties may be pronounced (more than 8,400 criminal procedures and 7,000 financial penalties in 2024).