health data
Published on January 2, 2025 at 10:34 a.m.
Genevière Allaire
Reading time 16 minutes
-Supplementary health organizations are required to process ever more health data as part of their activity. A task complicated by the special protection to which this sensitive information is subject and by the absence of consultation with Health Insurance.
From 2025, complementary health insurance could be called upon to play a strengthened role in fraud detection in collaboration with the National Health Insurance Fund (Cnam). Until now, compulsory health insurance (AMO) and supplementary health insurance organizations (Ocam) worked separately. A provision of the 2025 social security financing law planned to modify the framework for exchanges of information on suspected fraud between the two parties. If this measure is confirmed, depending on the evolution of the parliamentary situation, AMO and AMC could now communicate on the information strictly necessary to identify the author of the facts as well as on the acts and services concerned. This would be a first for complementary health insurance companies that have long been involved in the fight against fraud. Alas, the budget having been censored, the implementing decrees planned for early 2025 to specify the terms of exchanges between AMO and Ocam, could still be delayed…
Beyond their primary mission of liquidation and control of benefits, complementary health insurance companies are in fact called upon to process health data with a view to combating fraud. A phenomenon in full expansion and whose damage to all health insurers is estimated at €1.5 billion each year, with the corollary of price increases for policyholders. According to a…
