After the Orpéa scandal, another group of Ehpad is singled out. According to information from RMC, the company LNA Santé is at the origin of a health insurance fraud of nearly 1.2 million euros.
A bucolic name for a health establishment by the sea, in an idyllic setting: the Les Oiseaux health center, in Sanary-sur-Mer. A reference establishment, which has been welcoming and caring for overweight children and adolescents for 90 years, and which is now threatened. For months, healthcare and educational staff have been sounding the alarm. At the beginning of July, the establishment will close its doors. Definitively. The LNA health group, which has around 80 establishments in France, mostly nursing homes, and which bought Les Oiseaux in 2011, judges that the establishment is no longer “profitable” enough.
If we have heard a lot of the names of Orpéa and Korian in recent months, following the revelations of investigative journalist Victor Castanet in “Les Fossoyeurs”, the company LNA Santé, it had been more discreet. It is however one of the three health groups listed on the stock exchange in France, which published in 2021 a net result tripled to 23.5 million euros. In this context, it is difficult for the staff at the Sanary center to accept the argument of profitability.
“It is unacceptable. What will become of these children and young people who need this care? Profitability, we cannot hear it! Health is not a business, our children are not purses”, laments Christel Pons, dietician for more than 30 years in the establishment.
His colleague, Alice Colin, a specialist educator, is also sorry for the situation: “In a period when the pandemic has caused obesity to explode in France, we are talking about one in three young people in Europe affected by overweight problems. in Europe, we close the establishment in the Var which comes to answer this problem? It is total incomprehension.
“Numerous malfunctions” and “billing problems”
But why did the company want to close the center? In reality, the decision was taken following an inspection by the Var regional health agency in June 2019. In a report that RMC obtained, the ARS noted “many malfunctions”. “Beds unsuitable for overweight children”, “degraded” premises but also “billing problems”.
Concretely, for years, the LNA Santé group billed the health insurance for days of care while the establishment was closed. In 2019, for example, the center closed its doors five times, for school holidays. The ARS mission notes that billings to health insurance “did not neutralize these closing periods”. An organized system, since “all the checks confirmed this observation”. Similarly, the days of absence of the children were invoiced, as evidenced by a former doctor of the establishment, who wishes to remain anonymous.
“What was happening was that the patient was going out but we weren’t officially going out of the workforce, so the pricing could continue as if the patient was there when he wasn’t… It’s pure scam. It’s a way to make money on the backs of patients and on the backs of health insurance.”
In total, LNA Santé thus billed almost 1.2 million euros in a completely undue manner… “, and requires the reimbursement of the sums within two months.
Asked by RMC, Christophe Coquelin, director of operations for health activities at LNA Santé, claims to have “never set up a fraud system” but to have “resumed historical practices”. And to continue: “There were some mistakes that were made. This money was returned. No one is supposed to ignore the law but not everyone knows the whole law”.
The LNA Santé group also ensures that the closure of the establishment is not directly linked to the fact of having had to put an end to the fraud system, but recognizes that the decision was taken at the same time. “It did not generate the decision but it reinforced the decision that there was no possible economic model in this project,” admits Christophe Coquelin.
Although this type of fraud is liable to criminal prosecution, no complaint has yet been filed by the Health Insurance against LNA Health. Questioned by RMC, the National Health Insurance Fund claims to have “acted in order to preserve its financial interests which were important by notifying the undue and by initiating a penalty procedure for fraud”. The establishment would have been sanctioned, according to the CNAM, with a penalty of 40,000 euros.
A derisory sum in reality compared to the risk incurred. Especially since the amounts actually defrauded could be much higher than the figures announced, the fraud being in place from the takeover of the establishment in 2011, and the Health Insurance being only raised over a few years.
“Beyond the procedure for recovering undue invoices provided for by the Social Security Code, the CNAM still has the possibility today of filing a complaint with the Prosecutor”, explains Maitre Emma Léoty, lawyer specializing in financial law. Thus, in 2014, the Criminal Chamber of the Court of Cassation has already ruled that “the presentation of false invoices (to the CNAM) to obtain an undue reimbursement constitutes a fraudulent maneuver” to condemn a medical establishment on the basis of fraud. . A sentence punishable by 7 years in prison and a fine of 750,000 euros.