Two health centers have been de-conventionalized by Social Security for fraudulent practices, the damage of which amounts to almost 1.5 million euros, Health Insurance announced in a press release dated January 22. One of the two is a dental center based in Trappes. The other is an ophthalmology center located in Seine-Saint-Denis.
“These centers are accused in particular of having established false billing and of having invoiced fictitious actions, that is, not performed”, clarifies the National Health Insurance Fund (Cnam) in the press release.
Currently, 88 dental health centers and 44 ophthalmological health centers are subject to the control of the health funds, because “the development of dental and eye health centers had been favored to improve the supply of care. But the National Assembly voted at the end of November 2022 for a stricter framework for these structures, because some are presented as ATMs. »
So the organization made a decision. “In view of the seriousness of the facts and the amount of the financial damage”, which it estimates at “almost 1.5 million euros for these two centers”, the health insurance has decided to deconvention them “for a period of five year without delay,” the statement continued.
The dental center will be closed from 1 February
The measures taken will come into effect on Monday 23 January for the ophthalmology center in Seine-Saint-Denis and on 1 February next for the dental center in Trappes. What will be the consequences of these deviations? In fact, Social Security will only cover care on a very low basis, the so-called “authority” rate.
L’Assurance Maladie therefore “strongly advises its policyholders not to use these centers, all the more so in light of the fraudulent practices that have been discovered there. It recalls that the health centers have an obligation to inform patients of their prices and the conditions of care and exemption from advance fees,” the press release concludes.
As a reminder, Cnam, with more than 2,200 employees, is the operational bridgehead for the compulsory health insurance scheme in France. It leads, coordinates, advises and supports the action of the local organizations that make up its network. Negotiations with health professionals within the National Union of Health Insurance Funds (Uncam) are also governed by it.
PHOTO CREDIT: DRAWING