Health Insurance Fraud: 74% of €723m detected attributable to healthcare professionals
An IGF-IGAS report recommends refocusing anti-fraud controls on healthcare professionals, who are responsible for nearly 74% of detected fraud in 2025.
Healthcare professionals at the heart of health insurance fraud
Google News FR — Crime (fr) reports that the general inspectorates of the Ministry of Finance and Social Affairs (IGF and IGAS) recommend refocusing the fight against health insurance fraud on healthcare professionals, who are currently underrepresented in controls carried out by anti-fraud teams.
According to the latest figures from the National Health Insurance Fund, fraud committed by self-employed professionals accounts for nearly 74% of the €723 million detected in 2025. Private individuals account for only 16%, with the remainder attributable to healthcare establishments.
The report points to a notable imbalance in the distribution of control resources. Thirty per cent of cases dealt with involve losses of less than €1,000, mostly linked to frauds by policyholders. Conversely, only 3% of cases concern healthcare professionals, despite the fact that these matters can represent considerable financial stakes.
To correct this imbalance, the report recommends revising control priorities to target fraud with significant financial implications. It also recommends tightening procedures related to third-party payment, whose generalisation is said to have opened up new possibilities for fraudsters, and streamlining the process for imposing financial penalties on offenders caught red-handed.
In 2025, health centres lead the sectors concerned, with €138 million in detected fraud. They are followed by medical transport operators, at €62 million, then by nurses, with €60 million.
The report authors emphasise the need to better direct the resources allocated to combating fraud to tackle cases presenting the most significant financial losses as a priority.
Source: Google News FR — Crime (fr)