L\u2019Inspection g\u00e9n\u00e9rale des finances (IGF) et l\u2019Inspection g\u00e9n\u00e9rale des affaires sociales (IGAS) ont r\u00e9alis\u00e9 une revue de d\u00e9penses consacr\u00e9e \u00e0 la fraude aux prescriptions et aux facturations \u00e0 l\u2019assurance maladie. Dans un contexte o\u00f9 les d\u00e9penses du r\u00e9gime g\u00e9n\u00e9ral atteignent 244 Md\u20ac en 2024, la fraude d\u00e9tect\u00e9e s\u2019\u00e9l\u00e8ve \u00e0 628 M\u20ac, dont 70 % sont imputables \u00e0 des professionnels de sant\u00e9 ou \u00e0 des personnes usurpant ou falsifiant leur identit\u00e9. Cette fraude intervient dans un environnement marqu\u00e9 par la g\u00e9n\u00e9ralisation du tiers payant depuis 2016 et par la rapidit\u00e9 des remboursements, qui cr\u00e9ent des fragilit\u00e9s dans la cha\u00eene de paiement.<\/p>\n
Le rapport souligne que, si la d\u00e9tection de la fraude s\u2019est nettement am\u00e9lior\u00e9e ces derni\u00e8res ann\u00e9es, les r\u00e9sultats demeurent plus limit\u00e9s en mati\u00e8re de recouvrement des indus, avec seulement la moiti\u00e9 des montants frauduleux effectivement recouvr\u00e9s. Pour renforcer l\u2019efficacit\u00e9 de la lutte contre la fraude, les inspections recommandent un repositionnement des contr\u00f4les vers l\u2019amont du paiement. Cela passerait par une int\u00e9gration accrue de contr\u00f4les embarqu\u00e9s dans le syst\u00e8me de paiement afin de rejeter les indus avant versement, ainsi que par l\u2019adoption d\u2019une feuille de route pour d\u00e9ployer l\u2019ordonnance num\u00e9rique, pr\u00e9sent\u00e9e comme un levier cl\u00e9 de s\u00e9curisation de la cha\u00eene de prescription et de lutte contre les fausses ordonnances.<\/p>\n
Le rapport pr\u00e9conise \u00e9galement d\u2019optimiser les contr\u00f4les et leur ciblage en recourant davantage aux outils de science des donn\u00e9es pour d\u00e9tecter des sch\u00e9mas frauduleux \u00e9mergents. Il propose de r\u00e9orienter les contr\u00f4les vers les dossiers \u00e0 forts enjeux financiers, o\u00f9 les fraudes impliquant des professionnels de sant\u00e9 sont surrepr\u00e9sent\u00e9es. Enfin, il recommande de renforcer la coordination entre les caisses primaires d\u2019assurance maladie et les parquets afin d\u2019am\u00e9liorer l\u2019efficacit\u00e9 de l\u2019action contentieuse. Ces orientations s\u2019inscrivent dans les politiques publiques de ma\u00eetrise des d\u00e9penses de sant\u00e9 et de s\u00e9curisation des financements de l\u2019assurance maladie.\u00a0(contenu r\u00e9sum\u00e9 par l’IA)\u200bLire la Suite<\/a>\u200b<\/p>","protected":false},"excerpt":{"rendered":" L\u2019Inspection g\u00e9n\u00e9rale des finances (IGF) et l\u2019Inspection g\u00e9n\u00e9rale des affaires sociales (IGAS) ont r\u00e9alis\u00e9 une revue de d\u00e9penses consacr\u00e9e \u00e0 la fraude aux prescriptions et aux facturations \u00e0 l\u2019assurance maladie. […]<\/p>\n","protected":false},"author":1,"featured_media":7149,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[2],"tags":[227,202],"class_list":["post-15437","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sante-publique-et-systeme-de-soins","tag-ia","tag-vie-publique"],"_links":{"self":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/15437","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15437"}],"version-history":[{"count":0,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/15437\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/media\/7149"}],"wp:attachment":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}