Health insurance should focus more of its audits on healthcare professionals, according to a joint report by the General Inspectorate of Finance and the General Inspectorate of Social Affairs. The authors believe this shift would improve the effectiveness of the fight against fraud, without abandoning the monitoring of insured individuals.
In 2025, fraud committed by self-employed healthcare professionals, or by individuals presenting themselves as such, accounted for 73,5% of the €723 million detected and stopped. Fraud attributed to private individuals represented approximately 16% of this amount, with the remainder originating from healthcare facilities. However, 30% of the cases handled involved losses of less than €1,000, primarily related to insured individuals.
Three percent of cases account for 60% of the damages
The report highlights that a small proportion of cases account for the bulk of the embezzled funds. Just 3% of cases, mostly involving professionals, account for 60% of the total losses. The inspections therefore recommend better prioritization of investigations and a simplified application of financial penalties against professionals found guilty of fraud.
Healthcare centers, particularly dental and ophthalmology clinics, are projected to be the primary source of fraud detected in 2025, with €138 million. They are followed by hearing aid specialists (€86 million), medical transport providers (€62 million), and nurses (€60 million). The report also recommends improving the security of third-party payment systems, notably by strengthening the requirement to present the national health insurance card (Carte Vitale).
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