Fraud detected and stopped by health insurance has more than doubled in five years, reaching €628 million in 2024, a leap that illustrates the increase in anti-fraud efforts but also the industrialization of scams.
Of this amount, 416 million euros come from healthcare professionals in the community (68%), 109 million from social security beneficiaries themselves and the rest (14%) from hospitals, clinics and other healthcare establishments, according to figures published Thursday by the Health Insurance.
In the outpatient care sector, hearing aid specialists – or rather those who claim to be – are at the top of the list of professionals affected by fraud, with 115 million euros of fraud detected, a fourfold increase compared to 2023.
This is followed by pharmacists (62 million euros), nurses (56 million euros) and transporters (42 million euros).
"The reform of the 100% health system, which is very positive in terms of access to care" by allowing the fitting of hearing aids without any remaining costs, "has unfortunately also opened up a very diverse area of fraud (...)", with "fake companies, fake hearing aid specialists without qualifications, and well-organised fictitious invoicing sometimes between prescribers, hearing aid specialists and patients", explained Thomas Fatôme, the Director General of Health Insurance.
In 2024, the Health Insurance Agency thoroughly checked 55,000 hearing aid invoices and rejected 20,000 of them.
Seven people have been charged with involvement in a massive hearing aid fraud scheme that has caused losses to the health insurance system estimated at between 5 and 6 million euros, a judicial source announced on Thursday.
"Empty shell companies" in the Île-de-France, Hauts-de-France, and Grand Est regions billed for "fictitious procedures and undelivered equipment," the French health insurance agency told AFP. The suspects included "certain doctors" who "actively participated" in the fraud.
– “Parasites” –
On the side of social security beneficiaries, the Health Insurance system has identified and stopped €42 million in sick leave fraud, 2.4 times more than in 2023.
"This increase is mainly explained by a resurgence of fake sick leave certificates sold on social media, with ready-to-use kits made up of fake sick leave certificates – often lasting several months – and fake work certificates," says the Health Insurance.
Generally speaking, in just a few years, "we have moved from artisanal and somewhat opportunistic fraud (...) to fraud that is much more organized, much more professionalized and with increasingly sophisticated methods," explained Marc Scholler, deputy director of health insurance in charge of fraud.
This is due, according to him, in particular to the arrival of fraudsters "often from outside the world of health, who graft themselves onto it like parasites."
"We are seeing recruitment via social media, through advertising, (...) of mules for certain types of trafficking," that is to say, "people who lend their identity and participate" in fraudulent schemes "sometimes without their knowledge," he explained.
– Identity theft –
"We also have phishing and social engineering," particularly "to usurp the identity of a healthcare professional, an insured person, and therefore sometimes to benefit from services or undue billing," he added.
Faced with these new threats, the Health Insurance is improving its capabilities: it has equipped itself with new digital tools, increased its anti-fraud staff by 10% to reach 1,600 agents, and recruited statisticians and specialized investigators with judicial police powers, including cyber investigation.
Should we also create a biometric Vitale card, as political leaders regularly demand?
"Securing rights, that is, verifying that people who receive reimbursements have health insurance rights, is a priority," said Mr. Fatôme.
While recalling that a recent report from the General Inspectorate of Finance and the General Inspectorate of Social Affairs highlighted that the deployment of such a biometric Vitale card would be "absurd, costly, ineffective, and disproportionate."
According to the French Health Insurance Agency, in 2024, only 6 million euros of detected fraud was linked to a false identity.
Total health insurance expenditure will amount to approximately 257 billion euros in 2024.
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