A contentious article within a broader French bill aimed at combating social and fiscal fraud is igniting a dispute between opticians and health insurance providers, with the debate intensifying as the legislation moves toward a vote in the National Assembly. Article 5 of the proposed law, passed by the Senate in an expedited procedure, seeks to streamline the exchange of patient health data between healthcare professionals and mutuelles – France’s complementary health insurance organizations – as well as insurers and welfare institutions.
The core of the disagreement centers on the sectors where complementary health insurance covers the majority of reimbursements: dental, optical, and audiology. The legislation intends to legally facilitate and regulate the sharing of health data to more effectively identify and prevent fraud. However, opticians are resisting the requirement to share patient data, voicing concerns that this information could be leveraged by insurers to influence premium pricing, according to reporting from Le Parisien.
The proposed framework for data exchange has undergone amendments under pressure from opticians, according to Les Echos. Insurers estimate that approximately €1 billion in fraudulent transactions could be prevented through the implementation of Article 5. The article aims to establish a fresh legal framework for data exchange between the national health insurance system and complementary organizations.
The debate comes amid broader scrutiny of practices within the optical industry. A recent article in Le Point highlighted concerns about “tele-expertise” – remote eye exams conducted via online platforms – and alleged instances of fraudulent prescriptions for glasses issued based on limited assessments. The article cited concerns raised by the Snof, the national union of opticians, regarding companies like Sym Optic, Ophtacity, Plusbellemavue, Wyeexpert, Expertvision, Lyleoo, and Ordoptic.
Health Minister Stéphanie Rist acknowledged “derivatives” within the visual telemedicine sector, according to Le Point, and indicated that measures were being taken to address them. However, details of those measures remain limited. The prevalence of tele-expertise is significant, affecting approximately 1,800 stores out of a total of 16,784 optical businesses in France, according to INSEE data.
Sanclair, a health insurance provider, has publicly criticized the resistance to data sharing, arguing that a minority of healthcare professionals are using data protection as a pretext to conceal potentially fraudulent activities, as reported by L’Argus de l’Assurance. The organization alleges that hundreds of millions of euros are at stake.
An arrêté (order) from April 28, 2017, details requirements for informing patients about their social security rights, including those related to optical services, but does not directly address the current dispute over data sharing. The bill is now before the National Assembly, with no immediate timeline for a vote established.
