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 acts and non-compliance, on a repeated basis, with the rules of quotation and invoicing of acts”. 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. From 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 announcement is a “strong signal” according to Thomas Fatôme, the director general of the CNAM, who assures that “Medicare is determined to stop the fraudulent excesses of certain actors which are to the detriment of all: the community, patients but also 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 large-scale fraud in health centers”, explains the manager.
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 which “could be reassessed at nearly 21 million euros in total for the entire network, according to the elements of the investigation”, specifies the Health Insurance. The institution has been working for several months on a 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 Health Insurance. A new legislative arsenal, which establishes in particular the “establishment of ARS approval 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 it was “strongly mobilized” in the control of these centers which display “atypical” billings. No less than “88 dental health centers and 44 ophthalmological health centers” were now “subject to checks by the health insurance funds”.
