{"id":4125,"date":"2021-07-06T22:33:09","date_gmt":"2021-07-06T22:33:09","guid":{"rendered":"https:\/\/www.africa-press.net\/mali\/?p=4125"},"modified":"2021-07-06T20:29:32","modified_gmt":"2021-07-06T20:29:32","slug":"canam-un-joyau-fortement-eprouve-par-la-fraude","status":"publish","type":"post","link":"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude","title":{"rendered":"CANAM : Un joyau fortement \u00e9prouv\u00e9 par la fraude"},"content":{"rendered":"<p><span style=\"color: #ff6600\"><strong><a href=\"https:\/\/www.africa-press.net\/\">Africa-Press<\/a> &#8211; <a href=\"https:\/\/www.africa-press.net\/mali\">Mali<\/a>. <\/strong><\/span>On est manifestement loin de la vielle \u00e9poque o\u00f9 la Caisse nationale d\u2019assurance maladie inspirait la m\u00e9fiance et faisait face aux vagues \u00e0 peine r\u00e9sistibles des suspicions et pr\u00e9jug\u00e9s. Moins d\u2019une d\u00e9cennie d\u2019exp\u00e9rimentation et d\u2019\u00e9preuve auront suffi, en effet, pour qu\u2019elle s\u2019impose comme alternative irrempla\u00e7able au co\u00fbt insupportable de la sant\u00e9 au Mali. En t\u00e9moigne la grande convoitise dont est l\u2019objet son principal produit, l\u2019AMO, et qui se traduit par le recours \u00e0 des moyens frauduleux vari\u00e9s pour en b\u00e9n\u00e9ficier.<\/p>\n<p>Les balises et paravent de protection sont au fait cong\u00e9nitales \u00e0 la structure, mais elles se sont progressivement r\u00e9v\u00e9l\u00e9es peu efficaces contre les sollicitations indues, y compris pour l\u2019instauration de cartes biom\u00e9triques d\u2019identification pour identifier les contributeurs et b\u00e9n\u00e9ficiaires r\u00e9els de ses services. Ainsi, \u00e0 la lumi\u00e8re des \u00e9tudes et observations d\u2019expertises internes, les services de la CANAM retiennent plusieurs types de fraudes tant du c\u00f4t\u00e9 des usagers que de celui des partenaires -prestataires ou employ\u00e9s. Pour les usagers, la pratique frauduleuse se manifeste g\u00e9n\u00e9ralement par le recours \u00e0 diverses man\u0153uvres d\u2019accession aux pr\u00e9cieux services sanitaires sous une fausse identit\u00e9. C\u2019est le registre auquel appartenant l\u2019extension des prises en charge en soins et fournitures de m\u00e9dicaments \u00e0 d\u2019usagers non-contributeurs par le biais de cartes d\u2019adh\u00e9rents r\u00e9guliers. Le type de fraude est d\u2019autant plus transversal qu\u2019il implique les m\u00eames usurpations d\u2019identit\u00e9 et trafics \u00e0 l\u2019\u00e9tat-civil par le biais desquels des prestataires gr\u00e8vent les charges de la Caisse par des prestations endoss\u00e9es pour le compte d\u2019adh\u00e9rents fictifs et b\u00e9n\u00e9ficiaires indus. En clair, par complicit\u00e9 ou collusion d\u2019int\u00e9r\u00eat avec des prestataires des non-assur\u00e9s utilisent les cartes d\u2019assur\u00e9s pour acc\u00e9der \u00e0 des services auxquels ils n\u2019ont droit ni par la filiation avec les adh\u00e9rents r\u00e9els ni par leur contribution personnelle. Il en d\u00e9coule une foultitude de fausses prestations et services surfactur\u00e9s, qui s\u2019adossent sur des moyens dolosifs qui d\u00e9fient toute flagrance : quantit\u00e9s ou qualit\u00e9s abusives des soins ou produits pharmaceutiques, fr\u00e9quence de prises en charge des patients dans les m\u00eames structures et pour les m\u00eames motifs, entre autres.<\/p>\n<p>S\u2019y ajoute, du c\u00f4t\u00e9 des employeurs, une loi minoration de l\u2019assiette contributive imputable notamment au non-reversement des cotisations salariales pr\u00e9lev\u00e9s pour le compte de la Caisse.<\/p>\n<p>Face \u00e0 un ph\u00e9nom\u00e8ne qui menace la p\u00e9rennit\u00e9 du r\u00e9gime social aussi enviable, les responsables de la CANAM ne d\u00e9sarment pas. Un m\u00e9canisme de contr\u00f4le et de r\u00e9pression est ainsi \u00e0 pied d\u2019\u0153uvre et veille tant bien que mal \u00e0 la pr\u00e9vention, \u00e0 la d\u00e9tection ainsi qu\u2019\u00e0 la r\u00e9pression \u00e9ventuelle des pratiques frauduleuses. Il est notamment constitu\u00e9 d\u2019une instance supr\u00eame pilotage autour de laquelle gravite d\u2019autres organes dont l\u2019action aura permis de d\u00e9jouer des torts ou d\u2019en redresser dans nombre de cas, \u00e0 en juger notamment par une restitution massive de paiements ind\u00fbment per\u00e7us par des partenaires prestataires ou usagers de l\u2019AMO. Estim\u00e9 \u00e0 quelques dizaines de millions pour l\u2019ensemble du territoire, le remboursement des prestations frauduleuses s\u2019impose visiblement comme une solution pr\u00e9f\u00e9rable \u00e0 la r\u00e9pression p\u00e9nale pourtant pr\u00e9vue par les textes.<\/p>\n<p>Il reste qu\u2019une conjuration de la menace qui p\u00e8se sur le joyau social r\u00e9side dans sa n\u00e9cessaire protection contre les abus p\u00e9riph\u00e9riques ainsi que dans une prise de conscience collective de sa plausible disparition aux d\u00e9pens de ses adh\u00e9rents et potentiels adh\u00e9rents.<\/p>\n<p><b>A KE\u00cfTA temoin<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Africa-Press &#8211; Mali. On est manifestement loin de la vielle \u00e9poque o\u00f9 la Caisse nationale d\u2019assurance maladie inspirait la m\u00e9fiance et faisait face aux vagues \u00e0 peine r\u00e9sistibles des suspicions et pr\u00e9jug\u00e9s. Moins d\u2019une d\u00e9cennie d\u2019exp\u00e9rimentation et d\u2019\u00e9preuve auront suffi, en effet, pour qu\u2019elle s\u2019impose comme alternative irrempla\u00e7able au co\u00fbt insupportable de la sant\u00e9 au [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":4123,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,11,17],"tags":[76,86,19],"class_list":["post-4125","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-communaute","category-homepage-french","category-toutes-les-actualites","tag-africa-press","tag-africa-press-mali","tag-mali"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.1 (Yoast SEO v27.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CANAM : Un joyau fortement \u00e9prouv\u00e9 par la fraude - Mali<\/title>\n<meta name=\"description\" content=\"On est manifestement loin de la vielle \u00e9poque o\u00f9 la Caisse nationale d\u2019assurance maladie inspirait la m\u00e9fiance et faisai ...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CANAM : Un joyau fortement \u00e9prouv\u00e9 par la fraude\" \/>\n<meta property=\"og:description\" content=\"On est manifestement loin de la vielle \u00e9poque o\u00f9 la Caisse nationale d\u2019assurance maladie inspirait la m\u00e9fiance et faisai ...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\" \/>\n<meta property=\"og:site_name\" content=\"Mali\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/AfricaPressTunisiaa\" \/>\n<meta property=\"article:published_time\" content=\"2021-07-06T22:33:09+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/static.africa-press.net\/mali\/sites\/21\/2021\/07\/img-60e4bd09e1f2e.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"720\" \/>\n\t<meta property=\"og:image:height\" content=\"540\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"cfeditorfr\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"cfeditorfr\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\"},\"author\":{\"name\":\"cfeditorfr\",\"@id\":\"https:\/\/www.africa-press.net\/mali\/#\/schema\/person\/2b1cf3cd81a31e3cd26889ca66d677f1\"},\"headline\":\"CANAM : Un joyau fortement \u00e9prouv\u00e9 par la fraude\",\"datePublished\":\"2021-07-06T22:33:09+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\"},\"wordCount\":652,\"commentCount\":0,\"image\":{\"@id\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude#primaryimage\"},\"thumbnailUrl\":\"https:\/\/static.africa-press.net\/mali\/sites\/21\/2021\/07\/img-60e4bd09e1f2e.jpg\",\"keywords\":[\"Africa Press\",\"Africa Press-Mali\",\"mali\"],\"articleSection\":[\"Communaut\u00e9\",\"homepage-french\",\"Toutes les actualit\u00e9s\"],\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\",\"url\":\"https:\/\/www.africa-press.net\/mali\/communaute\/canam-un-joyau-fortement-eprouve-par-la-fraude\",\"name\":\"CANAM : Un joyau fortement \u00e9prouv\u00e9 par la fraude - 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