2023-07-21 16:47:20
For several months, Medicare has been mobilized in the control of these centers. PHILIPPE HUGUEN / AFP
Thirteen establishments of the Alliance Vision group will no longer be contracted from August 21. Medicare filed a complaint.
The ax fell again. After the deconvention of five health centers of the Alliance Vision group at the beginning of the year, Medicare announced this Friday, July 21 that thirteen others, distributed in nine regions, would be in turn. And this for a period of five years.
In a press release, the institution underlines that the centers in question are accused of “invoicing of fictitious procedures and repeated non-compliance with the rules for listing and invoicing of procedures“. These decisions were pronounced by the directors of the CPAMs concerned and notified to all the centers in mid-July.
The decision will take effect on August 21, 2023. As of this date, Medicare will only cover the care provided in these centers on a very low basis, called the “authority tariff“. For example, for an ophthalmology consultation billed at 30 euros, the patient will only receive a reimbursement of 1.22 euros. What discourage the greatest number to make an appointment in the centers of this group.
This ad is a “signal fort“according to Thomas Fatôme, the director general of the CNAM, who ensures that”Medicare is determined to stop fraudulent abuses of certain actors who are to the detriment of all: the community, the patients but also the professionals who respect the rules“. These results were “made possible by the strong mobilization of the teams in charge of the fight against fraud“who took part in”the first national task force set up at the end of 2020 on this major fraud in health centers“, explains the leader.
Read alsoIle-de-France: two health centers disapproved for “fraudulent practices”
27 criminal complaints filed
A total of 27 criminal complaints had been filed by the Primary Health Insurance Funds (CPAM) since June 2021, for damage estimated at the very least at 7.8 million euros. An amount whichcould be revalued at nearly 21 million euros in total for the entire network, according to the elements of the investigation“, specifies the Medicare. The institution has been working for several months on stricter supervision of these dental and ophthalmological health centers, some of which are presented as “cash machines».
Since May 21, the supervision of the activity of health centers has been further strengthened “thanks to the Khattabi law“, welcomes the Medicare. A new legislative arsenal, which establishes in particular the “establishment of ARS accreditation for dental, ophthalmological and orthoptist activities“, the “creation of a dental or medical committee» or even the «possibility of prohibiting the opening of a new center to the manager of a center that has already been suspended or closed».
Six months ago, Medicare said to itself “strongly mobilized“in the control of these centers that display billings”atypical“. Not less than “88 dental health centers and 44 eye health centers“were now doing”subject to checks by the health insurance funds».
In the wake of the Health Insurance announcement, Doctolib, a French heavyweight in scheduling medical appointments and teleconsultation, announced that it had decided “in view of the seriousness of the facts“, of “immediately suspend all online services of these centers and delist them from its services».
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