In its annual report on social security, the Court of Auditors estimates fraud in social benefits between 6 and 8 billion per year. It recommends targeting controls and improving collection.
The government is preparing a plan to fight against social fraud. These measures will accompany the plan against tax evasion. And a figure can enlighten the executive: the Court of Auditors estimates that fraud in social benefits represents between 6 and 8 billion euros. An estimate given Wednesday, May 24 in the annual report on the financing of Social Security. Half of this fraud concerns health insurance.
Out of this range of 6 to 8 billion euros per year, fraud against health insurance represents around 4 billion euros. Of this share, the vast majority, 80%, comes from professionals. A few examples: doctors are reimbursed for fictitious acts never performed; nurses declare acts incompatible with each other. The Court of Auditors also mentions a few physiotherapists or paramedics. And we are talking about fraud and not error. The other part of the range, apart from these health expenses, comes from the beneficiaries, the recipients. With fraud, for example on the RSA or the activity bonus.
“Targeted checks” which require “a certain political courage”
In any case, Pierre Moscovici, the president of the Court of Auditors, calls for really strengthening the controls, which are very insufficient. “Health insurance only checks 1 to 4% of the invoices issued by the various professions. No checks have been carried out since the health crisis on the bills of health establishments. None. on site than 3% of the 3.1 million households benefiting from the RSA. And therefore, we must very clearly change scale, change speed. There are two things that must be done. First, we must increase the means of control. And then secondly, these controls must be better targeted. And all that requires a certain political courage.” On the question of means, Pierre Moscovici points to the number of agents in charge of these checks: 3,400, where more are needed, according to the Court of Auditors.
The magistrates of the Court of Auditors also give ways to facilitate these checks. Beyond the workforce, they make technical recommendations to target and identify these frauds upstream. Prevent them, in fact. For example, against fraud committed by health professionals, computer systems should be improved. Updates would make it possible to block, for example, invoices for inconsistent acts. On the family branch, the Court proposes to review the application methods: the funds would not only rely on the income declared by the recipients themselves, but they could receive the data from third parties, for example Pôle emploi or employers.
And one of the issues is the recovery of amounts paid to fraudsters. How to recover this money and make it return to the coffers of the State? For now, the system is inefficient. Only 1 to 10% of the sums are recovered, according to the Court of Auditors. And again, it’s about targeting. The actions cannot be the same for professionals and for beneficiaries, according to Véronique Hamayon, president of the chamber of the Court of Auditors in charge of the annual report. “When it comes to health professionals, we can have a few big fraudsters, so a relatively small number of fraudsters for large amounts. Whereas when it comes to individuals, patients or social insured beneficiaries of “miscellaneous allowances, it’s the opposite. We have a very large number of beneficiaries for individual defrauded amounts which are relatively small. And so we have to do a lot, a lot of checks to be able to recover defrauded amounts.”
Finally, the Court of Auditors recommends further sanctioning all these fraudsters of social benefits.
2023-05-24 16:43:56
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