Fictitious acts, phantom patients, community clinics transformed into cash pumps: behind the Vitale card, a real silent heist is playing out. In a few years, highly structured networks have embezzled tens of millions of euros of public money by taking advantage of loopholes in theHealth Insurance and widespread third-party payment.
Since the Bachelot law of 2009, health centers exploded, nearly 3,000 structures, especially dental and ophthalmological, often in towns rather than in rural areas. “Some jumped into the breach, telling themselves that there was money to be made.“, denounced Fadila Khattabi on Radio France, before estimating that “The system has been misused”. Concern is growing: how far can this looting go?
Fraud in health centers: the 58 million affair which alerts the entire system
At the end of March, seven people were indicted, suspected of having embezzled 58 million euros via 18 centers, mainly dental, spread across the country. “This network has succeeded in robotizing the invoicing of fictitious acts“, explained a source close to the matter to Radio France. For Fabien Badinier, head of the fight against health insurance fraud, “This is an exceptional affair in terms of its scale.“. Searches, 300,000 euros in cash, money counter, false identities, jammers, accommodation “that he could leave in 30 seconds”: the investigators describe an operation worthy of organized crime.
The scammers opened or bought centers, declared dental treatments never carried out in the name of patients and phantom practitioners, sometimes with the approvals of deceased doctors. “We have crooks who are intelligent, who know the health system well, who have completed higher education,” noted General José Montull, head of the Central Office for the Fight against Illegal Work (OCLTI), on TF1. He recalled to Radio France: “We often have the impression that welfare fraud comes from individuals who are struggling to make ends meet. But this is not at all what emerges from our investigations“.”We are dealing with people who embezzle millions of euros and who have a high roller lifestyle..” For Marc Scholler, financial director of Cnam, “It is no longer opportunistic fraud” but “something new, extremely aggressive and whose objective is to plunder the system extremely quickly“.
Alliance Vision, Proxidentaire, Cosem: a user manual for the pillage of care
The ophthalmological network Vision Alliance
illustrates this mechanism. Thirteen centers were canceled, for damage estimated at 21 million euros and more than 82 million euros in revenue in four years. Behind XXL hours, sometimes unauthorized doctors, orthoptists or even secretaries carrying out medical procedures. “There was always this little pressure ‘you have to charge’. We quoted (billed, Editor’s note) funds from the eye for 80% of patients. Even if they were not made, we had to rate them“, Mathilde, a former secretary in Amiens, told Radio France. Non-profit associations managed the centers, but commercial companies linked to the managers billed for equipment or “advice” at rates intended, according to the investigation, to suck up reimbursements.
Dental side, the scandal Proxidentary left dozens of patients mutilated for 900,000 euros in damage to Social Security, while an alleged person responsible was able to relaunch a center in Alsace via a new structure renting its equipment to a company already in question. At Cosem, a historic network of health centers, whistleblowers described a luxurious lifestyle financed by healthcare money. “In fact, they took advantage of money from Social Security and mutual insurance to be able to live the high life, because that’s what they did, they lived the high life. This is completely abnormal“, denounced Sybil on Radio France. Health Insurance identified more than 600,000 euros of fictitious or redundant acts and imposed a million euros penalty.
When medical fraud turns into organized crime
The latest OCLTI surveys now describe 100% fictitious centers, without any patients. “In our latest surveys, we dealt with 100% fictitious health centers“, indicated General José Montull on Radio France, “empty shells” which usurp the data of real policyholders and disperse requests between funds “to delay the detection of fraud”. The same general explains having “observed in several of our recent investigations of money laundering networks which were also used by figures of French narco-banditry“. Fraudsters buy back cash from
drug trafficking and reinject it via their health companies, giving this fraud in health centers the appearance of a real organized crime.