2024-04-23 12:25:38
Ten dental health centers in the Nobel Santé + network, singled out for a series of frauds whose damage is estimated at some 2.9 million euros, will be defunded by Social Security, announced Tuesday April 23, Marguerite Cazeneuve, director health insurance delegate, on
In a press release, Health Insurance announced the initiation of withdrawal procedures once morest “ten centers of the same network, established [dans] four regions ».
Also read the explanations: Article reserved for our subscribers On Health Insurance, the vast project of the fight once morest fraud by health professionals
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Ten complaints filed
Health Insurance, which collaborated with the Central Office for Combating Illegal Work (OCLTI) in this case, explained that the investigations revealed “fraudulent and recurring practices”. In cause: “fictitious, multiple or inconsistent billings, non-compliance with good practice standards or the treatment conditions provided for in the nomenclature of technical procedures (CCAM), dilapidation of healthy teeth” according to the press release
The damage of nearly 2.9 million euros “represents nearly 20% of the dental expenditure amounts of these centers covered by Health Insurance”, specified the CNAM. The deregulations will take effect from May 13.
Four dental health centers located in Ile-de-France and Provence-Alpes-Côte d’Azur will be deregulated for five years, four others located in Ile-de-France and Nouvelle-Aquitaine for three years, and two others installed in Auvergne-Rhône-Alpes for one year. From the effective deconvention, the “Secu” will only reimburse the care provided in these centers on a very low basis, called the “authority rate”. ».
At the same time, the CNAM filed ten criminal complaints once morest these ten centers in the summer of 2023, for acts of fraud, forgery and use of forgery, false declarations with a view to obtaining or attempting to obtain a social protection body an undue payment.
Under the effect “major control campaigns targeting health centers, particularly [ceux appartenant à des] networks »more than 58 million euros in damage linked to health center fraud were “detected and stopped” in 2023, and “the mobilization of Health Insurance continues in 2024”insisted the CNAM.
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