Concerns over social fraud in France have been raised following a report indicating that 68.7 million individuals received healthcare reimbursements in 2022, despite the population being estimated at 67.8 million. Former magistrate Charles Prats questions the legitimacy of some beneficiaries, suggesting potential fraud. However, Health Insurance officials clarify that the databases used are not directly comparable and include various groups, such as expatriates and deceased individuals. While some fraud exists, it is significantly lower than often claimed.
Is Social Fraud a Reality in France?
Are we witnessing a significant increase in social fraud in France? Former magistrate Charles Prats has raised this concern on social media, highlighting a statistic shared by the Health Insurance. According to their website, a staggering ‘68.7 million’ individuals were reported as beneficiaries of reimbursed healthcare in 2022. This figure raises eyebrows, especially considering that Insee estimated the total population of France at 67.8 million for the same year.
Questioning the Validity of Beneficiaries
The question arises: could there be fictitious beneficiaries receiving funds from Social Security? Charles Prats posits that the extent of this fraud might be even more substantial. A publication from Drees revealed that in 2023, ‘one in five’ respondents admitted to not having consulted a doctor that year.
In response, Health Insurance officials have dismissed these claims as an ‘irrefutable sophism.’ Marc Scholler, the delegated director for Finance, Fraud Prevention, and Audit, clarified that ‘the existence of an individual in the Health Insurance databases does not automatically confer rights.’ He emphasized that the databases being compared are not compatible.
Health Insurance manages rights for various individuals, including those not residing in France. This category includes over one million retirees who have relocated abroad but are entitled to health coverage if they return to France, as they contributed during their working years.
Additionally, foreign students must be affiliated with Health Insurance, which is mandatory and free for both domestic and international students. Seasonal workers and cross-border employees are also included in the database, and about 600,000 EU workers are not immediately removed from the system after their contracts end, as many may return to France shortly after.
Moreover, the 68 million figure includes deceased individuals, as they remain in the database for 27 months post-mortem to allow for billing of any care received prior to their passing. Other reported cases include approximately 1.1 million individuals whose rights have expired and who can no longer claim reimbursements.
While Marc Scholler acknowledges that ‘social fraud exists,’ he asserts that the specific abuses discussed do not. Health Insurance estimates that unjustified charges related to insured individuals who continue to receive benefits amount to around 50 million euros, a significant figure but far less than the billions sometimes claimed annually.
Finally, the claim that a substantial portion of the population is not seeking medical care needs clarification. Drees’s data, which Prats cites, is based on self-reported information from individuals aged 18 and older. Health Insurance notes that the actual percentage of people not receiving care during a year is relatively low, as consultations with doctors are not always necessary to access care and obtain reimbursements.
Health Insurance aims to strengthen its efforts against social fraud while urging the public to challenge prevalent misconceptions. Issues such as inflated estimates of fraud by foreign-born individuals and the supposed high number of ‘excess vital cards’ are often exaggerated. Moreover, daily inspections reveal that a significant 70% of fraudulent claims stem from healthcare professionals billing for services that are either overcharged or entirely fictitious.
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