Alsace: Health insurance funds filed 180 fraud complaints in 2024

Across the ten departments concerned, a total of €38 million in fraud was detected. This figure represents a significant increase: €6.8 million more than the previous year. This sharp increase is not linked to an increase in the number of frauds or their amount, but more likely to the results of strategies developed by health insurance, based on awareness and prevention, but also on targeted controls and the use of new technologies. Anticipatory capabilities have thus been increased: more than half (56%) of the frauds detected in the Grand Est region in 2024 were stopped before the amounts were paid by health insurance.

These frauds are committed by social security beneficiaries (34% of cases in 2024) as well as by healthcare professionals, suppliers of medical goods, medical transporters or healthcare establishments. Once discovered, they give rise to severe sanctions. Some 66% of detected frauds have, in addition to the recovery of undue sums, been the subject of legal proceedings, penalties ordered by the CPAM, criminal complaint or reporting to the prosecutor, reporting to a professional council, “de-conventionnement” procedure… The law now allows primary funds to impose a penalty of up to three times the amount of the fraud (and up to four times in the case of fraud by an organized gang), even if it was not successful because it was stopped before any payment by the Health Insurance.

In the Alsatian departments alone, 180 criminal complaints or reports to the prosecutor were filed in 2024. The CPAMs of Bas-Rhin and Haut-Rhin also issued 106 financial penalties (sanctions similar to fines) ranging from 337 euros to 66,000 euros. That is 960,384 euros of penalties issued in total in 2024 in Alsace. In total, €12 million of fraud was detected and stopped by the CPAMs of Bas-Rhin and Haut-Rhin.