Savings made under the ONDAM in the fight against fraud in France 2018, by theme
In the context of the anti-fraud policy conducted by the French health insurance system, the savings made under the National Health Insurance Expenditure Target (ONDAM), a tool designed to control health insurance expenditure, amounted to 242.4 million euros in 2018. Most of these savings (almost 85 million euros) were achieved by strengthening the monitoring of healthcare professionals, providers and suppliers.
The first one of these areas concerns health professionals, providers and suppliers and targets irregularities in terms of activity, invoicing and services. The second aims to ensure that controls over public and private health institutions, as well as controls over double invoicing and community care services in medico-social institutions, are pursued. The next area, which concerns beneficiaries and employers, focuses on monitoring cash benefits, while the fourth covers basic rights and complementary health care. Moreover, according to the Health Insurance Expenses and Revenues report published in 2020, experiments on new data exploitation methods (datamining and big data technologies) are currently being conducted. Therefore, the fifth strategic axis focuses on these new methods to identify potential frauds.
Anti-fraud strategy of the ONDAM
The value of these savings illustrates the mobilization of the National Objective of Health Insurance Expenditure against fraud. In order to ensure a more effective control over the different players and services that may raise suspicions of fraudulent activities, the actions taken by ONDAM are organized around five main areas.The first one of these areas concerns health professionals, providers and suppliers and targets irregularities in terms of activity, invoicing and services. The second aims to ensure that controls over public and private health institutions, as well as controls over double invoicing and community care services in medico-social institutions, are pursued. The next area, which concerns beneficiaries and employers, focuses on monitoring cash benefits, while the fourth covers basic rights and complementary health care. Moreover, according to the Health Insurance Expenses and Revenues report published in 2020, experiments on new data exploitation methods (datamining and big data technologies) are currently being conducted. Therefore, the fifth strategic axis focuses on these new methods to identify potential frauds.
