2023-07-21 17:04:00
Health insurance will deconvention 13 ophthalmological and dental health centers of the Alliance Vision group, revealed this morning Le Parisien. In question, “invoicing of fictitious acts” and the “non-compliance, on a repeated basis, with the rules of quotation and invoicing of acts”, according to health insurance (Cnam). Clearly, the centers targeted overcharged for acts performed by social security or multiplied examinations, sometimes useless, to raise the bill.
The Cnam thus quotes billings for examinations, intended in particular to detect glaucoma, for children, while this disease develops especially after 40 years. In all, the damage could rise to 21 million euros.
If it is not the skills of the doctors, but the behaviors of the managers that are targeted in this case, these practices can represent a danger for the patient. “They do unnecessary systematic examinations, while the patient has not necessarily seen an ophthalmologist”, explains for example Laurence Desjardins, administrative and scientific director of the SFO (French society of ophthalmology), who participated in the study of this file. Result, “we can miss a pathology while the patient is falsely reassured, has the impression of having made a complete assessment”.
In this type of fraud, already identified previously in other centers, Thierry Bour, president of Snof (union of ophthalmologists of France), also evokes cases “of people taken care of in a completely shifted way. They come for conjunctivitis and come out with glasses. »
Check your bills
In case of doubt, the main advice given is to check the invoices carefully. After the examination, “you have to ask for the invoice for the act”, explains Thierry Bour, and then check on his Ameli account that the examinations or consultations given correspond to what was done. “Sometimes there are additional bills a few days later, it’s not normal, you have to ask,” says the doctor.
Last January, in another case, a man had thus found that after scaling in a dental office in Trappes (Yvelines), an invoice of 8079 euros had been deposited, for the laying of a crown. “He believed in a mistake at the beginning, then told a source close to the file. He went to the dental office but was offered the sum of 4,000 euros to remain silent, which he refused. »
But often in this kind of fraud, the patients concerned benefit from full refunds, “they pay nothing, so they will not go to see their bill behind”, declares Laurence Desjardins.
Who do I have in front of me?
Thierry Bour also underlines that it is not normal, at the time of the validation of the appointment, that one “specifies that it is an ophthalmological appointment, but not the name of the doctor”, which can maintain the vagueness on the consultation to come. In the Trappes case, dental assistants had for example been forced to perform procedures for which they had no qualifications, then reported Actu.
“It can be the medical secretary who does the first interrogations, when she is not a doctor, and the patient does not know it”, also indicates Laurence Desjardins, which can harm the diagnosis.
Other physicians also emphasize the importance of paying attention to price transparency. Health professionals are indeed required to display the prices of their consultation or certain increases, as well as the reimbursement prices, “visibly and legibly” in the waiting room or in the place of exercise, writes health insurance.
“The vast majority of health centers do quality work”
“The vast majority of health centres, whether municipal, mutualist or associative, carry out quality work”, supports the official Vie publique website. But these particular cases are harmful to the profession, as well as to the healthcare system.
Thomas Fantôme, Director General of Health Insurance, assures in the latest press release that the organization “is determined to stop the fraudulent excesses of certain actors which are to the detriment of all: the community, the patients but also the professionals who respect the rules “. 26 criminal complaints have been filed against the Alliance Vision centers concerned, “and this is not the end of the story, there will be other deconventions in the months to come”, assures Thomas Fantôme in our columns.
In the event of questionable practices in a health centre, the professionals interviewed advise reporting to social security or to the regional health agency in their region.
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