Widespread Fraudulent Practices Led to Closures

Seven health centers across France have been shuttered following the discovery of extensive fraudulent billing practices. The closures, which took place on Monday, affect a network of facilities suspected of systematically defrauding the national health insurance system. The financial impact is estimated to exceed €6.5 million.

The abrupt closure has left patients scrambling for alternatives. One local resident expressed surprise, stating, I am amazed that we can defraud, especially an ophthalmology center. Another patient simply resigned themselves to the situation, saying, You just have to look for another ophthalmologist.

Modus Operandi: overbilling and Fictitious Acts

The fraudulent scheme involved systematic overbilling for services rendered and the addition of charges for fictitious procedures. For example, a standard €90 consultation might have an additional €40 in fabricated charges tacked on. Because the patient is ultimately reimbursed,the fraud often goes unnoticed at the individual level.

Concretely, these are networks that are established, which are grafted on the system a bit like parasites. Their objective is to capture public money and make cash machines that succeed in enriching themselves.

Marc Scholler, director of health insurance

The Inquiry: A Collaborative Effort

Unmasking the complex scam required a coordinated effort between multiple agencies. According to a statement released by health insurance officials, the investigation involved in close collaboration by the National health Insurance Fund, and the gendarmerie and its Central Office for the Fight against illegal Work (OCLTI).

General José-Manuel montul, commander of the Central Office to Combat illegal Work (OCLTI), explained the nature of the fraud: From the creation of the center, there is a criminal project which consists in diverting money from health insurance. Sometimes there can be real care acts, but often it is to make up the fraudulent company.

The Role of Third-Party Payment Systems

The expansion of third-party payment systems, implemented as part of the 100% health reform under President Emmanuel Macron’s first term, inadvertently created opportunities for large-scale fraud. This system, designed to streamline healthcare access, has been exploited by unscrupulous health centers.

Combating Health Insurance Fraud: A National Priority

Health insurance fraud is a significant problem globally, costing billions annually. In the United States, for example, the National Health Care Anti-fraud Association estimates that healthcare fraud costs the nation tens of billions of dollars each year. Similar challenges exist in many European countries, highlighting the need for robust oversight and enforcement mechanisms.

The French government is now under pressure to strengthen its fraud detection and prevention measures to safeguard public funds and ensure the integrity of the healthcare system. This includes enhanced data analytics, increased audits, and stricter penalties for those found guilty of defrauding the system.

DGCCRF Report Highlights Widespread Non-Compliance in “100% Santé” Initiative

A recent investigation by the Direction Générale de la Concurrence, de la Consommation et de la Répression des Fraudes (DGCCRF), France’s consumer protection agency, has cast a shadow over the “100% Santé” program. The report reveals that a significant number of healthcare providers are failing to adhere to the program’s regulations, raising concerns about its effectiveness and potential for abuse.

Key Findings: A Troubling Trend

The DGCCRF’s investigation, conducted on April 3, 2025, scrutinized numerous healthcare establishments participating in the “100% Santé” initiative. The findings indicate that a staggering 75% of the inspected facilities were not fully compliant with the program’s requirements. This widespread non-compliance raises serious questions about the oversight and enforcement mechanisms in place.

This concerning statistic underscores the challenges in ensuring that healthcare providers adhere to the regulations designed to make essential services accessible to all citizens.The “100% Santé” program, aimed at providing fully reimbursed access to certain medical devices and treatments, is now under increased scrutiny.

Understanding the “100% Santé” program

Launched to eliminate out-of-pocket expenses for essential healthcare services, the “100% Santé” program covers a range of medical needs, including:

• Optical care (glasses)
• Dental care (dentures, crowns)
• Hearing aids

The program aims to improve access to healthcare for all French residents, nonetheless of their income level. However,the recent DGCCRF report suggests that the program’s goals are being undermined by widespread non-compliance.

Potential Consequences of Non-Compliance

The failure of healthcare providers to comply with “100% Santé” regulations can have several negative consequences:

• Patients may be incorrectly billed or charged for services that should be fully reimbursed.
• The program’s overall effectiveness in improving healthcare access is diminished.
• The integrity of the healthcare system is compromised, potentially leading to fraud and abuse.

fraudulent Activities and Financial Repercussions

Beyond simple non-compliance, the DGCCRF has also uncovered instances of outright fraud related to the “100% Santé” program. As 2023, authorities have detected approximately 90 million euros in fraudulent activities, involving 52 health centers. This highlights a systemic issue that demands immediate attention and stricter enforcement.

The current system relies heavily on trust, with patients often not verifying the accuracy of billed services due to the “no out-of-pocket expense” nature of the program. This lack of oversight creates opportunities for unscrupulous providers to exploit the system.

Patients have nothing to settle and therefore often do not check the care billed on their behalf in health insurance.

Moving Forward: Strengthening Oversight and Enforcement

Addressing the widespread non-compliance and fraud within the “100% santé” program requires a multi-faceted approach. Key steps include:

• Increased monitoring and auditing of healthcare providers.
• Stricter penalties for non-compliance and fraudulent activities.
• Enhanced patient education to encourage verification of billed services.
• Streamlining the reporting process for suspected fraud.

By implementing these measures, authorities can safeguard the integrity of the “100% Santé” program and ensure that it effectively achieves its goal of providing accessible and affordable healthcare for all.