The Financial Penalties Commission (CPF) is the obligatory part of the financial penalties procedures. Prior Agreement (MSAP) when the doctors have not themselves validated their guilt in prescribing work stoppages by accepting an MSO! This also poses a problem regarding their professional independence (art 4127-5 of the public health code).
Also the FMF filed a appeal for annulment of art R148-1 et seq. (introducing the MSO) to the Prime Minister and the Minister of Health on October 27, 2023. Without a response within 2 months (12/27/2023) he will return to Council of State to rule on this opposition between two regulatory texts.
The CPF is not a conventional commissionit is made up of two sections of 5 members, a social section (representatives of the CPAM council), and a professional section (representatives of professional unions designated by the Local Joint Commission). The CPF can only validly sit in the presence of a quorum of 6 members.. The CPAM provides the secretariat of the commission
In accordance with arts. L162-1-15, L114-17-2 and R148-7 of the social security code, the CPF must issue an opinion on the need for an MSAP and its duration which cannot exceed 6 months. This opinion is only advisory and the director may decide not to follow it..
The CPF is also responsible for deciding the amount of the penalty. imposed on the doctor who accepted an MSO and who did not achieve the set objective. The maximum amount is twice the monthly social security ceiling, or €7,332 in 2023.
The name of the commission where the term “penalties” appears and this duality of functions are particularly embarrassing for health insurance who wants to promote MSO, less time-consuming for them, readily calling it “ accompanying », so much so that in my department a commission convened in June 2023 was renamed “ commission de MSAP “, en lieu and in place of ” financial penalties commission » J
However, reality shows that Article L114-17-2 is located at the level of the chapter “ control and fight against fraud » of the social security code !
Throughout the summer, the Legal Unit (CJ) of the FMF accompanied by video conference many colleagues in most departments in front of the CPF. The novelty for the 2022/2023 campaign was the appearance of the criterion number of IJ/active patientsexcept that it is not part of the text that the CNAM intends to oppose to doctors (L162-1-115)!
The reception and holding of debates with the social section were a dependent department. We have seen and heard everything, from remarks bordering on politeness to awkward silences in front of sisters and brothers “breaking down” live under emotional pressure. The more invested and conscientious they are, the more they are affected by what amounts to harassment.
Obviously for the employers’ unions MEDEF, CGPME, doctors are a priori guilty of arresting their employees and they must be punished for this !
More surprising, when this representative of aggressive employers is also a member of the UNAPL supposed to defend liberals who are also doctors!
More surprising when worker unions, or even patient associations, side with employer organizations? How do they not realize that they “ shoot themselves in the foot » and that through doctors it is they sick people, workers who are targeted?
Everyone talks to us about solidarity social security and its sustainability, but how can they imagine that General Practitioners (GPs) like other primary care health professionals are not aware of it?
Who better than the GP knows that we are all potential patients?
Who better than these health professionals is in contact with suffering, illness, isolation and social problems?
Do they have the slightest idea of the social role of GPs, Nurses (IDE)… and I remember these tuned TVs, these changed light bulbs, these non-medical telephone calls, the help with the letters, with writing the check for the ‘EDF…
Are they aware that they are destroying this by dissuading young people from self-employed work and pushing the oldest who are still in combined employment and retirement towards a total cessation of activity?
Are they aware that the management of IJ involves many actors even if it is the doctor who signs the stopping prescription!
That MG does not have a “magic wand” to resolve problems where other actors are powerless: medical service, occupational medicine and their demographic problemsemployers (toxic ETS), secondary care medicine and its deadlines (ARS and authorizations)… But the legislator only intended that they ALONE be penalized!
Can they imagine how this campaign destabilized the MGs?
Do they realize the timing problemthe MSO/MSAP 2022/2023 campaign started just after the director asked GPs to actively take ALD patients without MT!
The end of the CPF campaign was marked by the absence of a quorum in a northern department preventing the commission from being held, and the refusal of video conference for the CPF of the CPAM of Girondeclearly the CJ of the FMF was annoying or even seen as hostile!
And CPAM directors disregarding the advice of the CPF, feeling “obligated” to report some MSAP nationally with I must say my region which stands out in particular on the Loire with I believe 100% MSAP against the advice of the CPF, and Isère which sends 15 doctors out of 25 targeted to MSAP, 60%!
This CPF “tour de France” has clearly highlighted the inability of the health insurance medical service, due to lack of staff, to fulfill its medical control task who then refers to the attending physician. So I wonder about its ability to validate tomorrow one by one the work stoppages of doctors placed under MSAP! In the past experience of the CJ, 99% of judgments are validated which is proof of this.
The analysis and feelings of the CJ of the FMF shows that the targeting of the CNAM only retained MGs with a atypical activity. But is it nevertheless criminal? Isn’t what matters that the termination is medically justified?
Statistics have difficulty translating this, and personally I persist in thinking that art. L162-1-15 and its “ comparable activity » are inapplicable as is because it is poorly written. Efficiently comparing the activity of doctors is a “mission impossible”, especially from a statistical query !
So all that for that?
Dr Marcel GARRIGOU-GRANDCHAMP, FMF LEGAL UNIT
Legislative texts:
2023-12-24 11:36:10
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