After targeted checks, health insurance identifies 30% of unjustified work stoppages

According to the director of the Cnam, 30% of work stoppages were found to be unjustified in 2023 after carrying out 270,000 targeted checks on insured persons in 2023.

Health insurance is concerned about the increase in spending on sick leave. Although part of this increase can be explained by “mechanical factors”, such as rising wages or population growth, there remains around “40%” of this growth “that we do not know how to explain”, assured the director of the National Health Insurance Fund (CNAM), Thomas Fatôme, on Franceinfo this Tuesday morning.

Targeting

“There are many factors” that can be considered to understand the evolution of sick leave expenditure, estimated Thomas Fatôme, citing “the relationship to work”, “working conditions” or even “psycho-social risks in the company”. But, he also said, there are also “unjustified work stoppages”. The Cnam carried out 1.2 million checks in 2023 which resulted, in one in five cases, in summonses to more precisely check the patient’s state of health. “We summoned 270,000 insured persons in 2023, on the basis of targeting”, he specified.

“We are looking at repetitive work stoppages, work stoppages where there is no consumption of care, where we say to ourselves [qu’il] “There may be a risk of abuse,” explained Thomas Fatôme. “In about 30% of cases, the work stoppage is not justified,” he added.

“It is not a question of casting anathema on doctors, nor on policyholders, nor on companies,” defended Thomas Fatôme. According to figures from the Cnam, daily allowance expenditure increased from 10.4 to 15.8 billion euros between 2015 and 2023, excluding covid-19.