The Lozère Common Social Security Fund steps up controls and the fight against fraud

Nicolas Perrin accorde une grande importance à la lutte contre la fraude. Midi Libre – Lucas Manouvrier

Qu’il s’agisse de santé, d’allocations familiales ou de travail, les fraudes ou tentatives de fraude sont nombreuses et conduisent à des préjudices conséquents.

The Lozère Common Social Security Fund (CCSS) manages the health (Health Insurance), family (Caf) and recovery (Urssaf) branches. The control and fight against fraud represent one of its missions, while these funds are prey to a rise in digital fraud and cybercrime.

The health sector

The CCSS of Lozère paid 476 million euros in health insurance benefits in 2023. Of this total, around 1.3 million Euros of payment were corrected following the 34,297 checks carried out. "There are errors on the part of the policyholders when making declarations, errors on our part (53 000 € returned to the policyholders), and fraud", lists Nicolas Perrin, director of the CCSS of Lozère. In fact, 39 frauds were detected. "They are judicially characterized by intentionality", specifies the director. This resulted in 33 warning letters, two penalty procedures, one filing of a complaint and a report to the Prosecutor. "There were 256 000 € of damage suffered and 521 000 € of harm avoided", concedes Nicolas Perrin.

"There were more health professionals than policyholders affected by fraud this year, details Régis Lacroix, litigation and fraud manager of the health branch at the CCSS de la Lozère. And 90 % of the amounts are attributable to health professionals." For the latter, the amounts embezzled can be very high (false declarations, acts fictitious, overbilling, mileage charges…). Even more so when they take place over time. "Sometimes, it is the policyholders who alert us because they consult their care sheet and notice errors" , continues the director.

The family branch

The family branch, linked to the Family Allowance Fund (Caf), generates less money than health (85 million euros paid) but makes also faced with "the limitless ingenuity of some to defraud", recalls Régis Lacroix. More than 5,400 inspections were carried out in 2023 by the CCSS, including 1,200 which resulted in regularization. Some of them resulted in complaints being filed (4) and fines of 1,000 euros; (15). On average, a fraud represented 9,294 euros, a significant sum received thanks to false declarations or scams on housing, family benefits, RSA, etc.

The recovery branch

Lozère companies have paid, in total, 240 million euros in contributions to the Union for the Recovery of Social Security Contributions and Family Allowances (Urssaf). 13.7 million of them were examined during more than 1,200 checks. At the same time, nineteen actions to combat illegal work were carried out by a controller and two Urssaf inspectors.

Strengthening the fight against fraud

The Joint Security Fund social will re-establish control home of insured persons on sick leave by a sworn investigating agent. Controls will also continue to detect situations of fraud concerning the Caf (composition of the household, presence at home, income, etc.).

Finally, artificial intelligence is one of the new control and fight against fraud tools. This technology will be able to use personal social data, declarations of employee hiring and the creation of activities.< /p> I subscribe to read more