Complaint against X for suspicion of invoicing fictitious anesthesia procedures during cataract operations

The AC! Anticorruption association announced on Friday, October 10, that it had filed a complaint against unknown individuals after cataract surgery patients reported that they had been billed for anaesthesia procedures that were deemed fictitious.

This complaint for "aggravated fraud against a body charged with a public service mission" and "forgery and use of forged documents" , of which Agence France-Presse (AFP) received a copy, was filed with the public health division of the Paris prosecutor's office. The document illustrates billing procedures carried out at the Louis-Pasteur clinic in Essey-lès-Nancy, in Meurthe-et-Moselle.

But in view of the number of reports already received by the association, more than 30 to date, "from patients spread across several departments" , it appears that these practices are not limited to this single clinic, "but could be part of a recurring modus operandi in other approved private establishments" , according to the text.

"The patients all underwent cataract surgery under topical anesthesia, consisting of the simple instillation of anesthetic drops or gel into the eye by an operating room nurse, without the presence or intervention of an anesthesiologist-resuscitator," we can read. However , "the clinic systematically billed the primary health insurance fund (CPAM) for an anesthesia procedure (ADA code) for an amount of 111 euros, and demanded an additional fee of approximately 100 euros from the patient."

"These sums were, for the part covered, reimbursed by Social Security, therefore from public funds, and for the remainder, called from the patients or their mutual insurance companies," it is further written. However, "no general or local anesthesia or anesthetic monitoring was carried out," according to the complaint. Contacted by the AFP, a representative of the clinic declared that he was "not aware of this complaint."

"The CPAM is in a bad way and it's high time everyone got involved," said Marcel Claude, president of AC! Anticorruption. "The CPAM recently emailed members to check the transactions on their Vitale cards, and we think it would be useful to launch a monitoring campaign by "green card" members ," he added.