CPAM Fraud Detection: Over EUR 3 Million Suspected Funds Found within This Department
In the Eure-et-Loir department, the Primary Health Insurance Fund (CPAM) reported a record-breaking €3,096,744 in penalties for fraudulent activities in 2024, marking a 62% increase from the previous year. This significant uptick was attributable to improved targeting and new control measures implemented by the CPAM.
According to Le Parisien, the CPAM has focused on prevention as part of its new strategy against fraud. This approach has led to enhanced targeting of suspicious activities and the cancellation of unjustified reimbursement claims.
CPAM officials confirmed that there are two primary categories of fraudsters. Social security policyholders, although numerous, typically commit smaller frauds. Conversely, healthcare professionals tend to commit more substantial fraud but are fewer in number. In 2024, over one hundred hearing aid societies under suspicion of fraudulent practices were subjected to inspection.
Hearing aid societies account for approximately 42% of the total damage recorded in 2024. The CPAM penalized €757,000 in excessive billing, preventing the payment of unwarranted benefits totaling €1,382,000. Although healthcare professionals were responsible for only 39% of fraud cases, they were responsible for 61% of the damage and 86% of the funds saved.
Fraudsters resort to various illicit strategies, such as identity theft, the falsification of policyholder documents, and overcharging for services by healthcare professionals. In nearly two-thirds of cases, the organization files a complaint. For the remaining cases, the CPAM applies alternative sanctions, including warnings in 12% of cases and financial penalties in 17%.
Eure-et-Loir's CPAM has job opportunities for professionals in fraud detection, such as the Investigateur Administratif Lutte Contre La Fraude en Apprentissage role. Approaches to combat fraud might entail increasing AI and machine learning capabilities, fostering cooperation between insurance funds and agencies, and launching public awareness campaigns.
Preventive measures often consist of robust data analysis systems, which are capable of detecting anomalies in claims and beneficiary data. Targeted fraud usually involves scrutiny of frequent sick leave claims, disability claims, and medical equipment and services. The most common types of fraud comprise the existence of ghost beneficiaries, fake sick leave claims, and overcharging for services.
In the realm of personal-finance and general-news, the Eure-et-Loir's CPAM, in addition to reporting significant increases in penalties for insurance fraud, has also been emphasizing crime-and-justice issues by focusing on prevention and enhanced targeting of suspicious activities. This strategy has led to a substantial reduction in unjustified reimbursement claims, with healthcare professionals being primarily responsible for the largest portion of fraud damages and funds saved.
