MIL OSI Translation. Government of the Republic of France statements from French to English –
Source: Republic of France in French The French Republic has issued the following statement:
Credits: © orelphoto – AdobeStock
Have you been faced with a refusal of treatment from a healthcare professional whom you consider discriminatory or with excessive fees? A decree published in the Official Journal on October 4, 2020 sets out the complaint and conciliation procedure to which you can resort as well as the penalties to which professionals are exposed as of January 1, 2021. Service-Public.fr explains.
What is a discriminatory denial of care?
Discriminatory refusal of care corresponds to practices tending to prevent or dissuade a person from accessing prevention or care measures, by any means whatsoever. These may in particular be obstacles preventing access to the health professional or to normal conditions of financial coverage of acts, services and health products.
According to the Penal Code, the grounds for discrimination are: origin, sex, marital status, pregnancy, physical appearance, particular vulnerability resulting from the patient’s economic situation, surname, place of residence, state of health, loss of autonomy, disability, genetic characteristics, mores, sexual orientation, gender identity, age, political opinions, union activities, ability to express in a language other than French, membership or non-membership (true or supposed) to an ethnic group, a nation, an alleged race or a specific religion.
Refusals of care towards a beneficiary of Universal Health Coverage (CMU), Solidarity Supplementary Health (CSS) or State Medical Aid (AME) are also considered discriminating.
What is an illegal or abusive fee overrun?
The text specifies that an illegal or abusive overrun corresponds to a failure to respect “tact and moderation”. To assess it, we look to see if the fees have been set, taking into account the complexity of the procedure performed, the time spent, the service provided to the patient, the notoriety of the practitioner, the percentage of procedures with overrun. or the average amount of overruns practiced, for an activity comparable with health professionals working in the same department or in the same administrative region.
The conciliation procedure
Mixed conciliation commissions specific to each health profession examine patient complaints. They are made up of representatives of the Local Health Insurance Fund (CPAM) and the National Council of the Order of Physicians (CDOM).
A person who considers himself to be the victim of one of the two breaches lodges a complaint with the director of the CPAM or the president of the CDOM who informs the practitioner concerned.
She mentions her own identity and contact details, the elements making it possible to identify the health professional implicated, and describe the alleged facts. This complaint gives rise to a conciliation procedure.
During this conciliation, the victim can be assisted or represented by a person of his choice (in particular by an approved association), as well as the professional. If this is not possible, the parties may address their observations in writing to the secretariat of the committee, specifying the reasons for the impediment.
Exceptionally, if all the participants cannot be brought together and if the parties agree, the conciliation can take place by videoconference or by telephone conference guaranteeing the confidentiality of the discussions.
At the end of the session, either:
the commission notes the conciliation and then puts an end to the dispute;
there is no conciliation (the complainant does not withdraw his complaint or at least one of the parties has not responded to the summons). The remaining points of disagreement are then entered in the record of the meeting which is sent to each of the parties, to the director of the CPAM and to the president of the CDOM. The complaint is then brought before the disciplinary chambers of the CDOM.
Note: There is no conciliation when it comes to a recurrence on the part of the practitioner (a conviction within the previous six years). In this case, the complaint is transmitted to the one of the two authorities which was not addressed in the first place and to the competent ordinal court. The president of the CDOM then informs the director of the CPAM of the decision rendered.
For a discriminatory refusal of care: a financial penalty equivalent to twice the monthly social security ceiling.
For illegal overruns: a penalty equivalent to twice the amount of overrun invoiced.
In the event of a repeat offense, the health professional may be prohibited from exceeding any excess for 3 years and suspended participation in the financing of his social contributions.
The professional’s conviction can be displayed in the public reception area of the CPAM for a period of 1 to 3 months following notification of the sanction.
In the event of a repeat offense and after exhaustion of legal remedies, the director of the CPAM may make this sanction public in any publication for local, departmental or regional distribution.
Note: An annual report on these complaints will be sent to the Minister of Health and Social Security, the Defender of Rights and the Refusal of Care Assessment Commissions.
EDITOR’S NOTE: This article is a translation. Apologies should the grammar and / or sentence structure not be perfect.