Systematic irrelevant examinations, billing for multiple acts ... "Operating anomalies" and "abuses" similar to fraud have been observed in ophthalmological health centers, establishments born of a legislative relaxation in 2018, have indicated, this Monday, concordant sources, confirming information from the Parisian .
According to the National Professional College of Ophthalmology (CNPO), the new name of the French Academy of Ophthalmology, these "unjustified acts" and these "highly questionable billing strategies" have been noted by "different sources" in recent months.
Deviations identified
"Checks have been initiated by the National Health Insurance Fund, which has also identified these deviations, while we are witnessing a rapid multiplication of the number of these centers," assured the CNPO, in a press release.
According to Le Parisien , who had access to an internal report from Health Insurance (Cnam), it is the surge in reimbursements claimed by these new type of health centers, in full swing since 2018, which would have caused arouse suspicion.
"For a patient base of 400,000 people in 2015 to 800,000 in 2019 (+ 100%), the cost of reimbursements soared by 245%", reaching "69 million euros," said this report, quoted by the daily. When questioned, the Health Insurance did not respond, this Monday, to requests from AFP.
No confusion with historic health centers
The development of these health centers is favored by the importance of the deadlines for obtaining an appointment with a liberal ophthalmologist. They are approved in sector 1, therefore prohibited from exceeding fees, and are accessible, sometimes, in less than 24 hours.
In its press release, the CNPO for its part warns against any "amalgam", in particular "with historic health centers, non-profit, designed on a mutualist model and traditionally managed by local authorities and institutions".
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