In recent years, the number of false medical certificates and false sick leave has exploded. Employers’ techniques for flushing out fraudsters have also multiplied. But what are you really risking by defrauding health insurance and your business? We come back to the consequences you can have!
For several months, many stories have been circulating around sick leave or medical certificates available on Snapchat. However, making a fake or buying a fake certificate that you are on leave is a bad idea. Indeed, employers now have numerous tools that allow them to flush out fraudsters. And I might as well tell you that you risk a lot if you get caught!
Sick leave: what is the legislation in force?
Of course, if you have a medical problem that requires you to take sick leave, then you should not hesitate to consult your general practitioner or a specialist who will be responsible for taking sick leave. However, the latter may be hesitant, since controls on doctors who are too generous in terms of medical certificates have increased in recent years. However, if he considers that your illness requires a break, then he will not hesitate to provide you with one.
Concerning sick leave, two situations arise:
- Either you have parts 1, 2 and 3, and you therefore have 48 hours to send parts 1 and 2 to the primary health insurance fund which is responsible for sending part 2 to its administrative department. You will also have 48 hours to send part 3, which does not include the reason for your stoppage, to your employer. The best is to have a trace and opt for registered mail.
- Either you only have part 3 which does not include any medical information to your employer, since your doctor will have already sent parts 1 and 2 to the primary health insurance fund. These are the most common cases.
Very important element, on parts 1 and 2 of your sick leave, it is indicated whether you have discharge times or not. These exit times will be decisive in the event of an inspection requested by your employer. Three scenarios may arise: no exit authorization, an obligation to be present at home from 9 a.m. to 11 a.m. and from 2 p.m. to 4 p.m. or exit authorization.
You still receive your salary during your sick leave. However, you may have waiting days, that is to say one to three days during which you will not receive your full salary. However, your employer can pay you your full salary in the event of subrogation – to find out, you must contact your company – or only part of your remuneration which will be compensated by daily allowances paid by the CPAM.
Techniques for identifying health insurance fraudsters
In certain cases, health insurance may decide to carry out checks to check whether you are in a state that does not allow you to work. In the case of false sick leave certificates which have proliferated on Snapchat, the CPAM can therefore take the decision, if it notes that numerous certificates come from the same doctor, to send a caregiver to your home. If you are prohibited from leaving or required to be present, you must be present in the event of an inspection. You will not be notified in advance.
On its website, the primary health insurance fund indicates that, in certain cases, your daily allowances may be reduced or eliminated. Here are the cases indicated by the CPAM :
- “ you refuse the inspection or if you do not attend the summons;
- your work stoppage is not or is no longer medically justified at the time of the inspection;
- you carry out an activity not authorized by your doctor;
- you do not respect the authorized exit times or you leave your department of residence without the prior agreement of your CPAM.»
However, health insurance is not the only organization authorized to request a check-up and your employer can also mandate a doctor to carry out a surprise counter-visit. There are a few rules. Your boss should ask a service specializing in checks or an independent doctor. If you benefit from a stopover with free exit, you must tell your employer when you are available for a visit. The costs associated with the inspection visit are the responsibility of your company.
What are the risks in the event of fraud?
If you are ever caught by your employer or by the CPAM in the act of fraud or if you have submitted a false medical certificate, you risk sanctions both from a professional point of view and from a legal point of view.
As a reminder, the site service-public.fr discusses the cases for which a sanction may be imposed:
- “ Absence of declaration of a change of situation (end of the situation of beneficiary for example), except in cases of good faith.
- False declaration on a right and benefit application form.
- Not telling the truth when declaring your situation and resources for payment of benefits.
- Refusal to provide information, failure to comply with summons, incomplete or excessively late response to the organization’s requests.
- Fraudulently obtaining a social security number. »
Health insurance fraud: professional sanctions
As mentioned, you risk professional sanctions if your employer ever realizes that you provided a false medical certificate. Among the possible sanctions, there is disciplinary sanction, of course, or dismissal for serious misconduct. Indeed, providing a false sick leave is an offense punishable by law. You will therefore not be entitled to notice or any severance pay. Furthermore, your employer can even file a complaint to hope to recover damage or request reimbursement of compensation that you could have received from your company.
Legal sanctions
You understand, health insurance fraud is an offense provided for in Article 441-10 of the Penal Code, in the event of production or possession of forgeries. Before going to court, however, you may be cut off from your daily allowances, or even have to reimburse them to the primary health insurance fund.
If your employer or a legal entity ever files a complaint against you, you risk a heavy fine, of up to 45,000 euros, as well as a sentence of up to 3 years in prison. You may, in extreme cases, be deprived of the exercise of your civic, civil and family rights, and deprived of the management of a business. It is therefore important to think carefully before buying a fake medical certificate on the internet!
