Infographic. Less than a third of the security fraud are committed by caregivers … but they represent two thirds of the amounts

The Minister of Labor. Nevertheless, Health, Solidarity and Families, Catherine Vautrin, has detailed the orientations of the bill aimed at combating social fraud, which should be examined by parliamentarians this fall. Furthermore, Health professionals are particularly in the government’s viewfinder.

The end of the year promises to be busy for parliamentarians. However, Between the bills of finance. Furthermore, social security financing for 2026, they will also have to examine another text, on the initiative of the government, which aims to fight against social fraud.

And for good reason, just for the year 2024, it is estimated at no less than 13 billion euros. Meanwhile, While the state is looking for substantial savings, 43.8 billion euros, including 5.5 billion health from next year, it is urgent to act.

But where do these security frauds come from? Contrary to popular belief, they “are not limited to insured and infographic. less than third security vital cards,” said the National Health Insurance Fund (CNAM). “The frauds are complex, mixing isolated practices and organized networks”.

68% of the detected amounts are defrauded by healthcare professionals – Infographic. less than third security

According to CNAM figures. in 2024, 52% of fraud in volume are committed by insured, against “only” 27% by caregivers in town and 21% for establishments.

But as a amount. the trend is very different: healthcare professionals in the city are at the origin of more than two thirds of the amounts defrauded and detected last year, 68% precisely, against only 18% for the insured. Health establishments are responsible for 14% of the sums defrauded and identified by the cells to combat security fraud.

Without Suprise, an important part of these frauds is linked to hearing centers whose fraudulent behaviors detected are exploding.

“If the detection of frauds committed by health professionals increased (+26 % compared to 2023). the detected and stopped infographic. less than third security fraud linked to hearing aids were multiplied by more than 5 in 1 year to reach 115 million euros (against 21 in 2023)”, says the CNAM.

Health centers, which grow like mushrooms on the territory in recent years, are also closely monitored. They are indeed at the origin of 39 million euros in fraud in 2024. which led to the disappointment of 30 establishments that year (against 21 in 2023).

Billing errors that cost expensive

Another significant part of fraud is also explained by billing errors committed by health professionals -. not necessarily voluntarily. In its report “charges. products” published at the end of June, the CNAM stresses that the Social hole is in part because of the invoicing errors committed by the masseurs-physiotherapists, estimated at 660 million euros. They amount to 566 million for liberal nurses or 502 million euros for pharmacists.

These amounts are considered to be “anomalies” by health infographic. less than third security insurance because it is. for example for physiotherapists and nurses, the invoicing by error of acts provided as a 100% security support for patients in long -term affection (ALD), while care is not in direct contact with the ALD. For pharmacists. it may be the invoicing of drugs not registered on prescription, or even the issuance of a treatment in quantity greater than the necessary quantity prescribed over the period.

Nevertheless. health professionals are not always in good faith: “Frauds Comis by nurses, for whom the damage detected and stopped amounts to 56 million euros, are mainly invoicing of unpaid acts, falsification of prescriptions or double invoicing,” said the CNAM. “As for the carriers. the invoicing of unpaid transport, kilometric surcharges or even the falsification of prescriptions explain an amount detected and stopped by 41.5 million euros,” she adds.