Suspicion of fraud at the health center in Bobigny: treatment will no longer be reimbursed for 5 years

The administrative court of Montreuil did not monitor the health center at the town hall in Bobigny. This center, specialized in ophthalmology and established in sector 1 on the ground floor of the tower on Avenue Paul-Éluard in Bobigny since 2021, challenged the health insurance’s decision to suspend reimbursement of treatment costs from August for five years. The request was rejected, as evidenced by an order dated November 14, which was known to Le Parisien.

The center, which has been suspended since August 7, condemned the insufficiently informed and disproportionate decision, which also harmed the center’s “35,000 patients” in a department where access to care is particularly difficult. In vain. The court did not find any anomalies in the health insurance procedure. A letter was sent to representatives of the center, and a meeting was held with them before the decision on deconvention was made by the joint commission.

Five years of non-compliance: This is the maximum penalty allowed by recent changes to the law. This allows Social Security to avoid having to wait until a criminal investigation is completed to stop paying benefits while fraud is suspected. Here the suspicions concern more than 300,000 euros. Something that the center disputes, as suggested by its lawyer Me Murad Battih at a hearing on November 9 in Montreuil. Answering the question, the latter did not comment on the refusal of the administrative court. The court also ordered the center to pay health insurance 1,000 euros to cover procedural costs.

“The center never opened”

Other health centers preceding Bobigny have been deregulated in Ile-de-France since February 2023, in Blanc-Mesnil, Trappes, Courbevoie, which usually leads to the permanent closure of these centers. In court, Me Sophie Tassel, a health insurance lawyer, was surprised that in Bobigny the town hall center was “opened on November 7th”. A health insurance agent noticed this. “Fake!” Mr Battih later countered: “The center never opened. He is a Sector 2 ophthalmologist who came to work for himself, using premises provided by the company, not the association. He stayed there for three days and has no plans to return.” .

The criminal investigation continues to shed light on suspected fraud. Health insurance also notified Bobigny’s prosecutor’s office of the anomalies discovered. The investigation was entrusted to the GIR of Seine-Saint-Denis.