Posted on Wednesday, September 30, 2015

The State and social security organizations are stepping up their actions against those who defraud or abuse and thus undermine the principle of equality before the public service.

The CNMSS is firmly in line with this public policy, which also contributes to controlling health insurance spending, by optimizing its organization, developing fields and techniques of investigation as well as strengthening external partnerships.

A notable increase in results

In 2014, the combined action of the departments of CNMSS, concerned by operations to fight against fraud and abusive behavior by certain healthcare professionals, healthcare establishments and insured persons, led to a notable increase in results:

  • 1,887 cases processed

  • € 2,052,421, amount notified in the context of abuse and fraud to health professionals, insured persons and health establishments, i.e. a 33% increase compared to 2013

  • 82.84%, corresponds to the recovery rate by the Accounting Agency, also up by 37%

  • € 1,536,705 of avoided damage, or the amount that corresponds to the sums that the CNMSS would have continued to pay if the damages had not been stopped, either a 36% increase compared to 2013
  • 27 litigation suites were initiated by the CNMSS : filing of complaints against a nurse, pharmacists, transporters, physiotherapists, and insured persons; reports to the Social Insurance Sections of a National Council of the Order for health professionals or warnings to insured persons and health professionals.
    All litigation proceedings initiated increased by more than 50%.

These actions are supplemented by the reports that everyone, insured as health professionals or actors in the social sphere, send us throughout the year.

We are all concerned and all responsible for defending our social protection system against the practices against which the CNMSS pledged to fight.

All reports must be communicated by phone on 04 94 16 97 01 or by email.