Assurance Maladie digital service and fraud initiatives

France’s national health insurance agency, Assurance Maladie, has introduced new digital initiatives to improve service delivery and combat fraud.

To address healthcare fraud, the agency launched a transparency initiative that sends insured individuals an email every ten days itemizing recent medical payments. This measure targets vulnerabilities in third-party payment systems where fraudulent billing, such as fictitious or inflated medical acts, often goes unnoticed. Marc Scholler, director of audit and fraud prevention, noted that audits in 2024 revealed 70 percent of infractions were committed by healthcare professionals. To assist monitoring, users can report suspicious activity through the Ameli portal.

Additionally, the agency has expanded the Compte ameli mobile application to allow for the digital submission of paper healthcare reimbursement forms. This feature enables users to photograph handwritten care sheets and upload them directly to their Caisse Primaire d’Assurance Maladie (CPAM). This service is restricted to handwritten sheets from practitioners outside of hospital settings for amounts under 100 euros, with a limit of five submissions per 30-day period.

The transition to digital submissions is intended for instances where a patient’s Vitale card is unavailable or a physician’s electronic transmission equipment is malfunctioning. Beyond increasing user convenience, the agency expects the shift to save millions of euros by eliminating postal costs and reducing manual administrative processing, as manual processing and postage for paper claims can cost between 1.50 and 2 euros per shipment.