French Medical Consultants Found Guilty of €180m Fraud

Seven professional associations, representing the cream of France’s medical consultants, have been found guilty of organising illegal consultation charges, at an estimated cost of €180 million to patients. The French competition authority (Conseil de la concurrence) has fined the associations a total of €814,000 for having systematically ‘recommended’ consultants to impose a higher charge for consultations than was otherwise permitted under the regulations. The associations involved included the main representative body for consultants, the Confédération des syndicats médicaux français (CSMF), as well as associations representing different health consultancy professions. The majority of medical consultants in France work for the health service on a self-employed basis, with remuneration paid through a fixed fee per consultation. The amount of the fee depends on the type of consultant and the nature of the consultation, but can vary from €28 to around €50. Consultants have long complained that these official rates are not high enough, so the Government has granted them the right to exceed these rates, a right they are obliged to use with ‘tact, and in a measured way’. The excess charge is known as a dépassement exceptionelle. These circumstances would normally occur if the duration of the consultation was particularly long, the patient was granted an early appointment, or a home visit was made, when not ordinarily required by the circumstances. Any excess charge over the official rate is not reimbursed by the health service, but is payable by the patient, or sometimes by their complementary health insurance policy, if they hold one. The Conseil de la concurrence found that between 2001-2005 the professional associations incited the consultants, on a collective basis, to charge the higher fee, whenever they thought they could get away with it. This included imposing the excess charge upon those who were otherwise entitled to free health care by virtue of their low-income. In such cases, patients were required themselves to pick up the excess. Whilst the competition authority did not deny the right of the associations to campaign on behalf of their members for an increase in the official rates, they considered that they were not entitled to take the form of concerted action that resulted in the self-enrichment of their members. It seems that the French Government itself became aware at an early stage that the abuse was taking place, but preferred not to take any action, presumably because it was an inexpensive way of dealing with the demand by the consultants for an increase in the official rates! The action against the consultants was brought the family association Familles rurales who, whilst satisfied by the decision, have expressed concern that there exists no mechanism through which the thousands of patients who have been overcharged will be reimbursed. Indeed, the fine imposed on the associations seems comparatively small (0.45%) compared to the size of the fraud committed by the consultants. The competition authority argued that they could not impose a higher penalty simply because the associations lacked the resources to pay a larger sum. No one seems to be arguing that the consultants themselves should be asked to dip into their pockets to reimburse patients, primarily because it would be difficult to identify with any precision who had been overcharged. The medical associations have appealed against the decision, arguing that it is an attack on the professional rights of their members. You can read more about consultant's charges in our comprehensive Guide to French Health Services.