Health insurance fraud: 73.5% attributable to healthcare professionals
An IGF-Igas report recommends refocusing anti-fraud controls on healthcare professionals, responsible for 73.5% of the €723 million in detected fraud.
Healthcare professionals at the centre of health insurance fraud
According to Google News FR — Crime (fr), a joint report by the General Inspectorate of Finance (IGF) and the General Inspectorate of Social Affairs (Igas), published in October 2025 and made public this week, recommends strengthening controls targeting healthcare professionals in matters of health insurance fraud.
The figures are striking: persons presenting themselves as healthcare professionals accounted for 73.5% of the €723 million in fraud detected and stopped by health insurance authorities. Individuals, by contrast, account for only 16% of the total.
The report points to a structural inefficiency in the current organisation of controls. Thirty per cent of cases handled by anti-fraud teams concern losses of less than 1,000 euros, for which insured individuals would be responsible. Conversely, 3% of cases account for 60% of the total loss — and most often involve professionals. The report therefore recommends "prioritising controls of healthcare professionals more, given the significant financial stakes involved".
The amounts vary considerably depending on the sectors. Dental and ophthalmic health centres lead the way with €138 million in detected and stopped fraud. Next come hearing aid dispensers (€86 million), patient transport providers (€62 million) and nurses (€60 million).
To tackle these practices, the report proposes better regulation of third-party payment, the expansion of which is said to have created new opportunities for fraud. Health insurance authorities are considering strengthening the requirement to present the health card to benefit from it, whilst simplifying applicable financial penalties.
Control of individual insured persons will not be abandoned. The report notes that low-value cases are subject to excessive leniency, which justifies maintaining vigilance in this segment, alongside the refocus on professionals.
Source: Google News FR — Crime (fr)