France
In France EHFCN has one member:
Caisse nationale de l’Assurance Maladie (CNAM)
National Health Insurance Fund (CNAM)
Caisse nationale de l’Assurance Maladie (CNAM)
The French National Health Insurance Fund (Caisse nationale de l’Assurance Maladie / CNAM) is the main public health insurer in France ; it covers 93 % of the French population (salaried workers, self employed workers, and students), through 101 local health insurance funds.
It is under the supervision of both the Social Security Ministry and Finance and Economy Ministry.
The August 2004 reform Law made health insurance have new responsibilities as far as healthcare system control is concerned. Thus, CNAM got reorganized and set up risk management as its priority. It also put in place a counterfraud directorate in 2005 and was one of the members which participated in the Ehfcn creation.
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 2 | Action | Compliance to regulations | All types of action once fraud is detected |
| 3 | Prevention | Compliance to regulations | Both soft and hard |
| 4 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
| 5 | Financial Check | Avoid waste/overconsumption | Overly expensive services |