A series of frauds whose damage is estimated at 2.9 million euros. This is the reason why Social Security removed ten dental health centers from the Nobel Santé+ network (out of the 22 it has), located in four regions.
“The fight against social fraud starts with the dismantling of these cash machines,” explained the number 2 of Health Insurance, Marguerite Cazeneuve, on X (ex-Twitter). Since January 2023, 31 centers have been suspended for fraudulent practices.
Fictitious billings
Health Insurance, which collaborated with the Central Office for Combating Illegal Work (OCLTI) in this case, explained that the investigations revealed “fraudulent and recurring practices”.
In particular, “fictitious, multiple or inconsistent billings”, “non-compliance with good practice standards or the treatment conditions provided for in the nomenclature of technical procedures”, and “damage to healthy teeth”, are at issue. according to the press release.
20% of dental expense amounts
The loss of nearly 2.9 million euros “represents almost 20% of the amounts of dental expenses of these centers covered by Health Insurance,” said the Cnam.
The deregulations will take effect from May 13. Four dental health centers located in Ile-de-France and Provence-Alpes-Côte d’Azur will be deregulated for five years, four located in Ile-de-France and Nouvelle-Aquitaine for three years, and two installed in Auvergne-Rhône -Alps for one year. From the effective deregulation, Social Security will only reimburse the care provided in these centers on a very low basis, called the “authority rate”.
Ten criminal complaints from the Cnam
At the same time, the Cnam filed ten criminal complaints against these ten centers in the summer of 2023, for acts of fraud, forgery and use of forgery, false declarations with a view to obtaining or attempting to obtain a social protection body an undue payment.
Under the effect of “major control campaigns targeting health centers, particularly networks”, more than 58 million euros in damage linked to health center fraud were “detected and stopped” in 2023, and “The mobilization of Health Insurance will continue in 2024,” insisted the Cnam.