Patients should be vigilant.
Health insurance announced a few days ago the “disappointment” of seven health centers of the same network distributed in five departments, for durations ranging from 4 to 5 years. Following the identification of inconsistencies in the invoicing of these establishments, the National Health Insurance Fund conducted investigations. These have revealed fraudulent and recurrent practices, namely invoicing of unpaid acts, acts carried out without the presence of health professionals or systematic invoicing of medical acts on instructions given to staff, without connection to the patient’s medical state. Financial damage to health insurance exceeds 6.6 million euros.
In the event of decontenting, the reimbursement of care by health insurance is done on a very low basis. This in fact diverts a majority of patients to contact the center. According to the Social Security Code, disappointed health centers have the obligation to inform patients of changes in management conditions and exemption in advance of costs, as well as prices. Health insurance will inform the appointment platforms so that they can update the price information put online for patients. Concretely, it will be much more expensive to get treatment there at what should lead these establishments to put the key under the door.
Contacted by the Women’s Journal, the CNAM communication department did not want to indicate the name of the decontentized centers “For legal reasons”. But the information was then provided to us by the union which represents the professional branch in question namely: ophthalmologists. In a statement of April 9, the SNOF (National Union of Ophthalmologists in France) informs that the seven disappointed centers belong to the “Express ophthalmology” network. The “Express Ophthalmology” centers disappointed for fraud are located in Burgundy-Franche-Comté, Grand-Est, Brittany, Ile-de-France and Normandy. Some are still open at a time when we write this article.
“This deconcentration decision confirms the alerts that we have launched for years on the excesses of certain health centers which divert the organization of care for purely lucrative purposes” reacted Vincent DEDES, president of the SNOF. People led to go to these establishments must be vigilant as to the increase in prices and the drop in reimbursements.
