The chance was too good for a bunch of fraudulent pharmacists… 151 million antigen tests were done in two years… 4 billion euros spent by health insurance (To which PCR tests are added, for a total amount of approximately 12 billion euros).
These sums attracted the greed of at least 34 pharmacies. Unscrupulous health professionals, who paid health insurance in bulk for faulty tests.
The embezzlement was huge even 18 million euros in false tests for one pharmacist, that management was alerted, checked the identity of the professionals supposed to have taken the tests, and soon realized the hoax. In all, 353 pharmacies have undergone or are under review. 150 files have been closed without further action, and 169 pharmacies are still undergoing the procedure.
Thomas Vatom, Director General of Health Insurance, explains the process developed on an industrial scale as follows: “In 9 cases out of 10, the pharmacy claims to have distributed the tests to a nurse, a doctor and a physiotherapist. The pharmacy will pay us for the tests it did not provide to these health professionals. “.
The Pharmacists Syndicate has seized several cases and demands several unions, such as the National Union of Community Pharmacists “The strongest toughness for her swindlers who degrade the image of an entire profession.”. Specialists in this sector recall that in total, 16,000 pharmacies conducted tests for two years, in the vast majority of cases, according to the rules.
In connection with 34 fraudulent files, 14 criminal complaints were filed by CNAM services, the largest fraudsters risk not only repayment of the collected amounts, but also a ban on practice or even imprisonment.
CNAM wants to better fight fraud by health professionals
The focus is on covid-related fraud, but health insurance generally wants to better combat fraud by health professionals. In 2019, the current Minister in charge of Vocational Education and Training, Carol Grundgin, estimated the number of health fraudsters at 30%, in large sums, because they alone represent 80% of the amount of embezzled funds.
To understand the source of fraud and how to reduce it, management has thus begun to screen care providers, profession by profession. For emancipated nurses, Thomas Vatom estimates between 5 and 8% of hidden fraud in health insurance refunds, against a bill of up to 400 million euros annually. By 2023, CNAM plans to evaluate small and large arrangements for general practitioners, physical therapists, dentists, or even biologists.