France's health insurance should target professionals more for fraud, report says

A recent report from France's general inspectorates of the Ministry of Finance and Social Affairs recommends a strategic shift in the national health insurance's fraud detection efforts. The findings suggest that the Assurance-maladie should prioritize investigations into healthcare professionals, rather than focusing heavily on individual policyholders.

The report highlights that fraud committed by liberal health professionals, or individuals posing as such, constituted a significant majority of the detected and halted fraud in 2025. This amounted to 73.5% of the total 723 million euros in fraud identified by the Assurance-maladie. In contrast, fraud by individuals represented approximately 16% of the total, with the remainder attributed to healthcare facilities.

Despite the substantial financial impact of professional fraud, the report notes that anti-fraud teams are currently processing a large number of smaller cases. Thirty percent of these cases involve individual policyholders and represent minor financial damages, often below 1,000 euros. Conversely, the report points out that only 3% of cases, typically involving healthcare professionals, account for 60% of the total financial prejudice.

To enhance the effectiveness of fraud prevention, the inspections propose tightening procedures related to the "tiers payant" (direct payment) system, which has presented new opportunities for fraudsters. Recommendations include strengthening the requirement for insured individuals to present their Vitale card for direct payment and simplifying the process for imposing financial penalties on professionals found to be engaging in fraudulent practices. The report emphasizes that concentrating on high-value cases involving professionals does not mean abandoning investigations into smaller financial fraud cases, as a significant reduction in oversight could lead to an unknown increase in fraudulent behavior.