First EHFCN Open House in Paris
The first EHFCN Open House took place in Paris on 10-11 June, successfully organised by CNAMTS, the French National Sickness Fund.
The concept of Open House was developed in order to offer member organisations a new opportunity to share experience and expertise with visiting colleagues who directly work in the fight against healthcare fraud and corruption. Although the first Open House should have taken place in Lisbon, Portugal in April 2010, it was postponed due to the Icelandic ash cloud. The French Open House, which had been prepared some time ago, became therefore the first one to be organised.
The Open House proved to be a very good chance for participants to listen and get new ideas to improve their daily practice. Pierre Fender, Director of the Litigation Control and Fraud Prevention Department explained how his department was set up a few years ago, both at national level and through the regional network throughout the country.
Through the implementation of four units (investigation and prevention of fraud, misconduct and abuse; litigation control law; litigation control and statistics; training and strategic monitoring) the department managed to reach impressive results amounting to over €130 million savings in 2009, and to almost €500 million savings in total since 2005. He explained the seven key principles of the strategy, ranging from the end goals to the four professional actions: detection, investigation, disputes and communication.
The other presentations went into further details through the work of each unit. Participants listened how fraudulent transport suppliers were detected and how they were consequently deterred from committing further fraud. Graphs clearly showed that there had been a decrease in fraudulent behaviours after CNAMTS had launched this prevention programme and that more than €28 million were estimated to have been saved one year after the implementation of the programme. CNAMTS lawyer explained the legal procedures for financial sanctions and how these had increased from less than 50 in 2006 to over 500 in 2009, whilst always respecting the rights of the defence of suspicious fraudsters.
The second day of the Open House listened to the control of healthcare professionals, to the use of statistics as tools to deter fraud, to the training of professionals in counter-fraud activities and finally about the overcharge of institutions such as hospitals. Accounts were given on how healthcare professionals were ‘accompanied' and if needed deterred from committing fraud and abuses; how only the smallest percentage of suspected fraudsters with the biggest deviation was further investigated, and how this technique hit exactly those who committed fraud; how training of CNAMTS personnel involved in counter-fraud activities had been developed; finally, how overcharge was sanctioned, but also how undue amounts had decreased between 2006 and 2009.
EHFCN thanks the CNAMTS and particularly former Director-General a.i. Gabriel Bacq for organising this Open House. Participants unanimously agreed that such an event was an added value for members in terms of share of best practices and cost-effective training of staff and exchange of ideas. This is a type of activity which EHFCN will continue promoting. The speakers' presentations can be found on our extranet (in French at the moment).
