2023-10-06 01:47:53
Hearing aids billed to Social Security when patients have never seen the color, prescriptions of convenience or even devices billed different from those actually delivered. The National Health Insurance Fund is launching the hunt for hearing aid scams. It must be said that fraud could cost the Social Security funds several tens of millions of euros per year.
A booming phenomenon since the implementation on January 1, 2021 of 100% health. This system allows full reimbursement of certain hearing aids, prescription glasses or even dental prostheses without any out-of-pocket costs for the patient. “In terms of access to care, it is a major success and it also made it possible to lower prices by 12%,” recalled Thomas Fatôme, the general director of health insurance, during a press conference. this Thursday in Paris. But when there are more expenses, mechanically, we see phenomena of fraud appear which are not negligible. »
The proof in Bobigny, in Seine-Saint-Denis. At the end of 2022, patient reports “turned the indicators to red”, summarizes Aurélie Combas-Richard, the head of health insurance in 93. On the third floor of a modern building, 22 seasoned agents track fraud. After Paris, it is the most important team in France. To their credit, several deregulations of dental or ophthalmic centers, where care is almost no longer reimbursed to patients. For hearing aids, their interest focused on two companies in particular, with “atypical” billing. “The prescriptions arrived from the same health center, patients from all over France, and the average age was 24 years,” notes the CPAM. Much younger than the national average.
Two complaints were filed, a transfer of funds of 2 million euros abroad was allegedly blocked, as part of an investigation which is still ongoing. The two companies, whose names have not been communicated, have reportedly ceased their activity.
Checking with policyholders by telephone
These suspicions triggered a series of in-depth checks of the invoices. “We carried out checks directly with policyholders, by telephone, with simple questions,” explains Aurélie Combas-Richard. For example, do you have a hearing aid? » And the responses of the insured are often eloquent, such as the absence of equipment or for one ear while the note sent to Social Security mentioned equipment for both organs. When the answer is no, there is a wolf.
The affair led Social Security to deepen its checks. In particular by targeting more broadly the 2023 bills of beneficiaries of complementary solidarity health insurance. The approach is successful since the Cnam calculates the fraudulent or unjustified reimbursements avoided at 3.7 million euros. In the process, investigators looked at the 2022 invoices sent by hearing aid professionals to Social Security. And there, new jackpot! Cnam discovers 2.3 million euros in undue payments due to non-compliant invoices.
In total, in the department of Seine-Saint-Denis alone, hearing aid fraud reaches an amount of 8.3 million euros. “In addition to the first two complaints, a dozen others were filed in several departments,” specifies Health Insurance.
130 centers in the crosshairs soon to be controlled
Faced with this observation, checks of the files of beneficiaries of complementary solidarity health insurance who have received a hearing aid are being deployed throughout France but particularly in Île-de-France.
130 centers suspected of fraud will be checked in the coming weeks. “They’re not hearing aid professionals, they’re business people!” » reacts Luis Godinho, vice-president of the Union of Hearing Aid Professionals. 5,600 are registered in France, 350 new each year, leaving the training sites with their state diploma in hand, after a bac + 3. They are responsible for adapting the equipment to the patient and ensuring follow-up. By prescription only. Only a doctor can prescribe a hearing aid. “The difficulty is that anyone can take a door step and hire a hearing aid professional to open a center,” laments the union, which notably recommends that reimbursements be linked to professionals and no longer to centers.
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