The Court of Auditors recommended on Monday "strengthening" the fight against health insurance fraud, particularly to stem an "unprecedented situation" of increased spending, set at 265.4 billion euros for 2025, an increase of 4.81 billion euros per year since 2019 (before Covid).
The share of health insurance expenditure in the gross domestic product "has increased, reaching 8.9% in 2025, compared to 8.2% before the health crisis," the Court recalls in a summary note on health insurance expenditure.
This "unprecedented situation" is "no longer sustainable," Pierre Moscovici, First President of the Court of Auditors, told the press.
Such an increase "is accompanied by a deterioration in the balance of the three branches of social security (illness, work accidents and occupational diseases, autonomy) which finance the National Health Insurance Expenditure Objective (Ondam)", deplores the Court of Auditors.
The cumulative annual deficit of these three branches "would almost double from 2024 (11.8 billion euros) to 2028 (20.1 billion euros)" and this would lead "to the reconstitution of a social debt in three years of more than 70 billion" from 2025 to 2028, the institution further emphasizes.
Among these three avenues for "improving the efficiency of spending", the Court of Auditors identifies "as a first priority" the fight, "to be strengthened", against "health insurance fraud and undue reimbursements of health expenses".
"Although progressing, the results obtained (628 million cases of fraud detected and stopped in 2024) remain significantly below the fraud estimates (up to 4.5 billion euros)," the Court of Auditors further highlights, which sets a target of 1.5 billion cases of fraud detected and stopped in 2029.
The additional resources "granted to health insurance funds, in terms of personnel, legal prerogatives and IT resources, are all levers to better prevent fraud and reimburse undue amounts," the Court of Auditors analyses.
"Controls must be made systematic and payments must be suspended in case of doubt," the institution insists.
Generally speaking, the necessary control of health expenditure "can be achieved while respecting the basic principles of Social Security," Mr. Moscovici said.
"The ridge line is narrow," but "it is possible" to make savings "without degrading the quality of service" and even by "improving it," he said.
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