2023-07-21 08:31:51
Thirteen health centers of the Alliance Vision group, pinned for a series of frauds, will be deconventioned by the Secu, announced Friday the direction of the Health Insurance. “After the deconvention of five health centers at the beginning of 2023, Health Insurance is for the first time initiating a large-scale deconvention procedure, once morest 13 health centers in the same network, located in nine regions”detailed the national health insurance fund (CNAM) in a press release.
Concretely, from the effective deconvention, the Sécu will reimburse the care practiced in these centers only on a very low basis called the “authority tariff”or for example for an ophthalmology consultation at 30 euros a reimbursement of 1.22 euros, explains the Health Insurance.
“Fictitious deed invoices”
The CNAM accuses the ophthalmological and dental centers of the Alliance Vision group of “invoicing of fictitious acts and the repeated non-compliance with the rules of quotation and invoicing of acts”. These deconventions will take effect on August 21, 2023. The CNAM recalls that criminal actions targeting the centers of this network are in progress, following the filing of 27 complaints by the Primary Health Insurance Funds since June 2021.
“The financial damage quantified by Health Insurance amounts to 7.8 million euros in the context of the complaints filed and might be reassessed in total for the entire network at nearly 21 million euros, according to the elements of the investigation”reported the CNAM in the press release. “These simultaneous deconventions of more than a dozen health centers, from the same network, send a strong signal”reacted the director general of Health Insurance Thomas Fatôme, quoted in the press release.
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