The 13 establishments of the Alliance Vision group, specializing in ophthalmic and dental care, will no longer be under agreement from this Friday, July 21. Health Insurance filed a complaint after receiving suspicious invoices.
Health Insurance has decided to strike hard. She is about to deconvene the 13 establishments of the Alliance Vision group spread over the whole of French territory, reveals Friday July 21 franceinfo. This private chain, which offers both ophthalmic and dental care, is suspected of having set up a system of health insurance fraud, for an estimated sum of more than 20 million euros.
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These centers billed Social Security for acts that its doctors had never performed or which were totally unjustified. This is the case, for example, of optical imaging examinations or retinography to detect glaucoma, retinal degeneration, diseases that mainly affect the elderly. However, according to information from franceinfo, these examinations were carried out or supposedly carried out regularly on children, sometimes aged three years. Another fraud concerning dental care, a prosthesis could be billed to a patient twice for the same tooth.
The bill for a consultation with a practitioner he has “never seen”
Leo, for example, went to one of these centers in Paris for an annual check-up. At 22, without having a sight problem, he explains that he “felt the scam during the consultation. There were a lot of people in the waiting room for consultations that lasted between 5 and 10 minutes“. An appointment is then fixed with an orthoptist, he must pass several examinations: “I didn’t feel it was helpful. I’m 22 years old, looking on the internet, it didn’t really match…“.
Most of the time, patients were unaware of the scam. Since the care was fully covered by Social Security, they paid nothing and often did not even check the bills. But Leo, he winced, when he received the bill for a consultation with an ophthalmologist he did not have “never seen. The only contact I had with him was his prescription stamp.“. The young man then tries to find out a little more: “I see on the invoice that there is some for 96 euros, and I try to understand with the secretary. His only answer was ‘in any case you don’t have to pay anything, it’s social security that will take care of everything or your mutual insurance company. You, it doesn’t concern you what happened“.
Like Leo, several patients have yet realized the scam. Some have alerted the Health Insurance, sometimes also warned by the employees of the establishments in question, who have denounced their employer.
27 complaints filed
Health insurance filed a complaint with the courts after also noticing the fraud by receiving very high bills. A total of 27 criminal complaints target the Alliance Vision channel. The damage is colossal, is estimated “just over 20 million euros”, details the head of Health Insurance Thomas Fatôme, for whom “we are there to reimburse care that is justified and not for fraudulent practices“.”It is normal that we cease to agree. In these cases, we continue to reimburse at very low levels, for example for a consultation of 25 euros, it is 1.20 euros of reimbursement“, adds Thomas Fatôme.
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By disabling 13 centers at once, Health Insurance wants to dissuade those who would be tempted to defraud: when patients learn that appointments with dentists or ophthalmologists in these centers are no longer reimbursed by Social Security, they stop making appointments; these health centers thus lose almost all sources of income. Last year, the Health Insurance identified and stopped 200 million euros of fraud on the part of health professionals.