Suspicions of fraud in a health center in Bobigny: care will no longer be reimbursed for 5 years

Suspicions of fraud in a health center in Bobigny: care will no longer be reimbursed for 5 years

The Montreuil administrative court did not follow the health center at the Town Hall in Bobigny. This center specializing in ophthalmology and approved in sector 1, on the ground floor of a tower, avenue Paul-Eluard, in Bobigny since 2021, contested the health insurance decision to suspend, since August and for five years, reimbursement of care. Request rejected, as evidenced by the order dated November 14, of which Le Parisien was aware.

The center, which has been suspended since August 7, denounced an insufficiently reasoned and disproportionate decision, which was also detrimental to the “35,000 patients of the center”, in a department where access to care is particularly difficult. In vain. The court did not find any anomaly in the health insurance procedure. A letter was sent to the representatives of the center and a meeting took place with them before the deconvention decision, taken by a joint committee.

Five years of non-compliance: this is the maximum sanction, permitted by a recent legislative change. It allows Social Security not to wait for the end of a criminal investigation to put an end to reimbursements, as long as suspicions of fraud exist. Here, suspicions relate to more than 300,000 euros. What the center contests, as its defender, Me Mourad Battikh, suggested at the hearing on November 9, in Montreuil. When asked, the latter did not comment on the rejection of the request by the administrative court. The court also ordered the center to pay 1,000 euros to the health insurance for procedural costs.

“The center has not reopened”

Other medical centers before that of Bobigny have been deregulated in Ile-de-France since February 2023, in Blanc-Mesnil, Trappes, Courbevoie, which generally leads to the permanent closure of these centers. In court, Me Sophie Tassel, health insurance lawyer, was surprised that in Bobigny, the Town Hall center was “open on November 7”. A health insurance agent noticed this. ” Fake ! » Mr. Battikh later retorted: “The center has not reopened. This is an ophthalmologist in sector 2, who came to work for himself, who used the premises made available by the company and not by the association. He stayed three days and doesn’t plan to come back.”

The criminal investigation is continuing to shed light on suspicions of fraud. Health insurance also alerted the Bobigny public prosecutor’s office of the anomalies observed. The Seine-Saint-Denis GIR was entrusted with the investigations.

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