Billing and healthcare: 3 out of 4 clinics non-compliant

The issue of billing in healthcare facilities is of crucial importance within our healthcare system, directly affecting the financial situation of patients faced with often costly care.

Recently, an investigation conducted by the DGCCRF revealed that nearly 75% of the clinics inspected showed billing irregularities, highlighting concerning practices that warrant close scrutiny. This context raises questions about healthcare regulation and the way patient information is provided, making a thorough review of the obligations incumbent on healthcare facilities essential.

By examining the healthcare measures implemented by the DGCCRF, we will consider the results of the inspections and the consequences of deficient practices on consumer safety. Who are the real winners and losers in this situation? Let us explore together the issues behind these figures.

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What are the main irregularities identified by the DGCCRF in healthcare facilities?

Billing in healthcare facilities is a subject that raises numerous concerns, particularly regarding the billing irregularities identified by the DGCCRF. These irregularities, which mainly affect medical and non-medical services, call into question the transparency of the information provided to patients. In 2023 and 2024, the DGCCRF thus conducted an investigation among 123 healthcare facilities, revealing that nearly 75% of them displayed at least one irregularity in their billing practices.

Here are some of the most frequently observed irregularities:

These irregularities highlight the flaws in the information system intended for patients, who are sometimes poorly informed of the costs to which they may be exposed. The lack of clarity regarding medical and non-medical services may lead to a decline in patients' trust and purchasing power, prompting the DGCCRF to intensify its inspections in order to protect consumers.

The results of this investigation reflect an urgent need to bring healthcare facilities into compliance with regulatory requirements. The next steps consist of examining how the DGCCRF ensures consumer protection against billing irregularities.

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How does the DGCCRF ensure consumer protection against billing irregularities?

The DGCCRF, as a regulatory authority, plays an essential role in monitoring billing practices in healthcare facilities. Its main objective is to ensure consumer safety by making sure that patient information is not only clear but also compliant with legal requirements. To achieve this objective, several measures and tools are implemented.

First of all, the DGCCRF carries out regular inspections within healthcare facilities. These inspections make it possible to quickly detect irregularities in medical services and billing conditions. During these inspections, dedicated teams verify not only the compliance of the displayed prices but also adherence to patient information obligations.

The DGCCRF's main actions include:

• Compliance audits: Analysis of billing documents and supporting records to ensure transparency of practices.
• Investigation of complaints: Receipt and processing of patient complaints concerning identified irregularities.
• Information campaigns: Raising patients' awareness of their rights and of the steps to follow in the event of a dispute.

In addition, the DGCCRF works with other healthcare bodies to improve healthcare regulation and to encourage facilities to comply with applicable standards. For example, the Act to modernize our healthcare system requires facilities to ensure transparent information that is accessible to patients. This includes, in particular, updating pricing tables and displaying the rights of insured persons.

The results of these efforts are measured by statistics showing a reduction in irregularities in healthcare measures over time. Nevertheless, challenges remain, particularly with regard to raising patients' awareness of the means of challenging billing and the importance of their role in the process of monitoring the quality of care.

In light of this finding, we will examine the consequences of non-compliance in matters of billing and the repercussions this may have on healthcare facilities as well as on the patients themselves.

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What are the consequences of billing non-compliance in healthcare facilities?

Non-compliance in matters of billing in healthcare facilities gives rise to significant consequences both for the facilities and for patients as consumers. When irregular billing practices are uncovered, this can affect not only the reputation of the facilities but also patients' trust, a crucial element in the healthcare sector.

One of the immediate consequences of these irregularities is the risk of administrative penalties. Following the 2023 and 2024 investigation, the DGCCRF issued numerous warnings and injunctions to cease practices, while administrative fines were imposed for failures to display information and for billing conditions that did not comply with the French Public Health Code. These fines, which amount to more than €160,000, are heavy for the facilities, especially when one considers the already substantial costs of healthcare.

Among the short-term impacts, the following can be observed:

• Decline in trust: Patients may become reluctant to seek care in facilities that have been flagged for billing irregularities, which may affect their attendance.
• Impact on finances: In addition to the fines, additional costs may arise to rectify the identified instances of non-compliance, leading to increased expenses for the facilities.
• Legal risk: Facilities may also face legal action from dissatisfied patients, resulting in additional costs for legal counsel and the handling of disputes.

In the long term, these instances of non-compliance may lead to a forced change in practices within healthcare facilities. The DGCCRF's announcements, such as consumer mediation, are intended to strengthen consumer protection mechanisms and encourage facilities to amend their practices in order to comply with the regulations. This also reflects a need for ongoing education on patients' rights and the obligations of facilities.

Despite the improvement measures already observed – with a large number of facilities having had to come into compliance following interventions – vigilance remains necessary. Patients are therefore encouraged to be proactive in requesting information and to exercise discernment when receiving invoices.

In this context, reflecting on the implications of billing irregularities underscores the importance of clear and accessible information for patients. It also raises the question of facilities' commitment to complying with standards, and of the impacts on the integrity of the healthcare system as a whole.

For more information, please feel free to consult the DGCCRF article: https://www.economie.gouv.fr/dgccrf/laction-de-la-dgccrf/les-enquetes/facturation-en-etablissement-de-sante-3-cliniques-sur-4-en.