assemblee-nationale/projet-de-loi-relatif-a-la-lutte-contre-les-fraudes-sociales-52985
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Amendement 538 — art. 5 #1443

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Jocelyn Dessigny
b5a251fea1 Amendement 538 — art. 5 
Dispositif :

    I. – A l'alinéa 4, après le mot :
    « regroupés »
    insérer les mots :
    « regroupés ou détaillés lorsqu'ils sont strictement nécessaires à la prévention, à la détection et à la caractérisation d'une fraude ».
    II. – En conséquence, à l'alinéa 28, après le mot :
    « regroupés »
    insérer les mots :
    « regroupés ou détaillés lorsqu'ils sont strictement nécessaires à la prévention, à la détection et à la caractérisation d'une fraude »
    III. – En conséquence, à l'alinéa 59, après le mot :
    « regroupés »
    insérer les mots :
    « regroupés ou détaillés lorsqu'ils sont strictement nécessaires à la prévention, à la détection et à la caractérisation d'une fraude »

Exposé sommaire :

    La lutte contre les fraudes en matière de santé nécessite que les organismes complémentaires puissent, dans des conditions strictement encadrées, accéder aux données détaillées indispensables à la vérification des actes facturés et au respect des plafonds réglementaires et conventionnels.
    En l'absence d'accès à ces données, les organismes ne sont pas en mesure de contrôler la conformité des actes ni de détecter certaines pratiques frauduleuses, notamment en matière d'optique, de dentaire ou de dispositifs médicaux. Une restriction excessive des données accessibles pourrait ainsi fragiliser les mécanismes de contrôle et favoriser le maintien de versements indus.
    À terme, une telle situation conduirait soit à une uniformisation prudente des garanties, au détriment des assurés bénéficiant de couvertures renforcées prévues par certaines conventions collectives, soit à une augmentation des cotisations destinée à compenser les pertes liées à la fraude. Dans les deux cas, la charge serait indirectement reportée sur les assurés.
    Le présent amendement vise donc à concilier l'objectif de lutte contre la fraude avec la protection des données de santé, en autorisant l'accès aux données strictement nécessaires en cas d'indices sérieux de fraude, tout en interdisant explicitement toute utilisation à des fins commerciales, de segmentation ou de tarification individuelle.

Sort : Tombé | Déposé le 20/02/2026
Source : https://www.assemblee-nationale.fr/dyn/opendata/AMANR5L17PO838901BTC2250P0D1N000538.xml

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Groupe: RN
Angit-Diff: auto
 2026-02-20 12:00:00 +02:00