2023-10-05 16:15:23
Health Insurance is intensifying its fight once morest hearing aid fraud, fully reimbursed by Social Security since 2021. Scammers bill patients, without the latter realizing it.
Health Insurance has decided to intensify its fight once morest fraud. 150 million euros were detected in the first half of the year, she announced Thursday October 5. Among the priorities, the fight once morest hearing aid fraud, in vogue among scammers since certain prostheses have been fully reimbursed by Social Security for almost three years.
>> Hearing aids: how Social Security tracks organized fraud
Their scheme is simple. These hearing aid sellers bill Social Security for the devices on behalf of patients, who sometimes have never set foot in their store. As it is reimbursed, it is painless for the insured, but not for the finances of Health Insurance.
Theft of Social Security numbers
“I don’t have a hearing aid, nor my children nor my husband. I am surprised, I don’t know how this person was able to take my Social Security number,” deplores this victim, who received a statement from Health Insurance for 3,000 euros worth of hearing aids. The Seine-Saint-Denis Health Insurance Fund receives telephone calls like this every day from policyholders.
The bill comes from crooks that this lady has never seen and who own well-established hearing aid stores. These scammers operate on a large scale. Aurélie Combas-Richard, the director of the Seine-Saint-Denis health insurance fund, spreads out three sheets of paper on her desk in front of us.
Very structured networks
“What you see there are three prescriptions, strictly identical, which concern three different insured persons. We see the same signature, the same diagnosis. It’s a copy and paste”notes the director, who mentions “very structured networks, which sometimes have several stores in different departments of Ile de France.” So, the Seine-Saint-Denis Health Insurance fund decided to check and recheck all hearing aid bills from last year and this year.
>> Health Insurance fraud: 80% is the work of professionals, points out the Court of Auditors which regrets the lack of controls
“We check if there is a medical prescription, if it is correct, if there has been a delivery, via telephone calls. If the billing is compliant, we pay, otherwise we do not pay.” explains Audrey Arbona-Paupy, head of the anti-fraud department. For the year 2023, the damage is estimated at 8 million euros.
Thanks to patient reports and systematic cross-checking, 360 stores were checked, 3,000 invoices examined and the Seine-Saint-Denis Health Insurance has just filed 14 complaints with the courts.
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