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La Fraude En Assurance Maladie: Diagnostic Et Therapeutique by Soro-D

La Fraude En Assurance Maladie: Diagnostic Et Therapeutique

by Soro-D
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Book cover type: Paperback
  • ISBN13: 9786131577161
  • Binding: Paperback
  • Subject: N/A
  • Publisher: Omniscriptum
  • Publisher Imprint: Omniscriptum
  • Publication Date:
  • Pages: 76
  • Original Price: USD 41.0
  • Language: French
  • Edition: N/A
  • Item Weight: 123 grams
  • BISAC Subject(s): Management

La fraude reste l'une des principales causes du déficit des portefeuilles d'assurance maladie, tant en assurance privée que sociale. Les moyens pour l'identifier et l'éradiquer restent un perpétuel débat. L'ouvrage tente de dégager des pistes pour répondre à cette problématique d'identification de la fraude et de son traitement. Il présente d'abord les risques traditionnellement couverts au titre du contrat d'assurance maladie. Ensuite, il identifie les origines de la fraude, tant à la soucription du contrat, qu'en cours d'exécution dudit contrat. Il identifie également les fraudes pouvant survenir au niveau de chaque acteur impliqué dans la chaîne de prise en charge d'un assuré en santé. Enfin, l'ouvrage dégage des pistes d'éradication de la fraude diagnostiquée. Ces pistes impliquent des mesures juridiques, médicales, techniques et d'organisation du système d'information et de gestion de l'assurance santé. Il importe de noter que l'analyse bien qu'ayant lieu chez des assureurs privées, est valable pour l'essentiel des cas étudiés, pour tout type d'assurance maladie (sociale, mutuelle, etc...).

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