Posted Nov 28, 2022, 6:30 AM
Turn of the screw in sight for health centers. MEPs are due to discuss this week a bill aimed at “improving the supervision” of centers specializing in dental and ophthalmological care by subjecting them to an approval procedure.
Already adopted in committee last Wednesday, the proposal, presented by MP Fadila Khattabi (Renaissance) wants to learn the lessons of the scandals of the dental centers Dentexia (2016) and Proxidentaire (2021) from which patients had emerged mutilated. It also aims to prevent all kinds of “drifts” likely to be noted in these flourishing centers, particularly in Ile-de-France and in the south-east of the country.
Because if these establishments are often constituted in the form of associations, some may seek to maximize their profits to the detriment of Social Security. In particular by inflating the bill of care to be reimbursed by Health Insurance.
Hence the project to require these structures to be approved by the regional health agencies (ARS). This “will allow the ARS to have control”, insists Fadila Khattabi, also noting that “health centers can be set up where it is not necessary”.
Existing in the past, this requirement for approval was removed in 2009 to facilitate access to care. But this “simplification has actually led to many practices contrary to the regulations in force”, deplores his proposal.
Monitoring of diplomas
Parliament had already wanted to go back in the 2022 Social Security budget but the provision had been rejected, on the form, by the Constitutional Council.
The new draft framework specifies that in order to be approved, the centers will have to compile a file presenting the “health project” or even “the declarations of the links and conflicts of interest of all the members of the governing body”. They will also have to send to the ARS and to the order of the health professions concerned, the diplomas and the employment contracts of the practitioners.
A way to ensure that centers rely on well-qualified caregivers who are not put under pressure to enrich the structure in which they work to the detriment of patients and Social Security. Granted on a provisional basis, the approval would only become final 12 months after the opening and subject to a visit by the ARS.
Two centers in the process of deconvention
Existing centers will also have to apply for approval and will no longer be able to provide care if they do not have the green light within two years. The proposal, containing measures facilitating the monitoring of the activity of the centers over time, also raises the level of penalties applicable in the event of breach, with a ceiling of 300,000 euros.
The initiative is closely followed by the association La Dent Bleue, resulting from the grouping of victims of the Dentexia and Proxidentaire scandals and is welcomed by certain professionals. “We think that the proposal can restore order in the sector”, notes Thierry Bour of the National Union of Ophthalmologists of France. “We can think that some of the current managers will leave centers that will no longer be profitable enough”.
The proposal is also “fully” supported by the Health Insurance. “There is a dynamic of installation of the centers and a certain number of these centers practice invoicing which does not comply with the rules of the game”, estimates Thomas Fatôme, the director of the National Health Insurance Fund (CNAM) .
Reserves of professionals
The CNAM is also on the offensive to prevent abuse. “Fifty-one dental centers are currently being checked (for suspicion of fraud) and we have just initiated the deconvention of two centers in the Paris region, a dental center and an ophthalmology center”. In other words, the acts carried out in these structures should no longer be reimbursed. “Other cancellations will follow in the coming weeks. »
On the side of the managers of the centers, the project arouses reservations. “We are supporters of this law, there is a need for regulation”, assures a spokesperson for the Union of dental health centers (UCSD) which brings together a little more than 200.
On the other hand, the organization ensures that it will be very vigilant on the implementation of approvals for existing centers. In particular, it takes a dim view of the fact that an ARS could refuse approval on the grounds that the targeted location area would already be “saturated”.