a nurse convicted of social security fraud

It was a major fraud which ended up arousing the distrust of the primary health insurance fund of Bouches-du-Rhône (CPAM 13). The result: inflated billings and reimbursements by an unscrupulous nurse. As reported by Provence and confirmed to Figaro by the defense of CPAM 13, the man was convicted and convicted by the Marseille criminal court during the month of December for this serious fraud.

According to our colleagues, this private nurse with no history was suspected of having significantly overbilled for his care services between January 2016 and May 2017. Amounts of up to several hundred thousand euros were thus declared to health insurance and a portion not negligible “reimbursed” to the fraudster.

“He was overactive, we are talking about an amount nine times higher than the average reimbursement in the department. This activity was incompatible with his status as an entrepreneur.underlines Me Ahmed Farghaly, of the BBLM firm, who represented CPAM 13 with his colleague Gilles Martha. More than 200,000 euros were thus embezzled by the caregiver, who ended up being caught by health insurance.

“Common” frauds

At the hearing, the defendant pleaded “the error” created by a «fatigue». “He denied the fraudulent intention but not the materiality of the facts”underlines Me Farghaly. A line of defense which did not convince the court, sentencing him to a two-year suspended prison sentence. According to Provencea fine of 30,000 euros and a five-year ban on practicing were also imposed on him. Finally, the man will have to reimburse the CPAM to the tune of 180,000 euros.

Last April, a nurse from Marseille was also sentenced to five years in prison, three of which were suspended on probation, for having invoiced tens of thousands of fictitious acts between 2017 and 2020. This time, the estimated damage was around 1.5 million euros. “These fraud practices are common with the national health insurance fund”confirms Me Farghaly.