Specialist lawyer in litigation with the CPAM

Are you looking for a lawyer for disputes with CPAM regarding recovery of undue payments or financial penalties or proceedings before the social insurance section? Macfarlanes LLP provides you with professionals in social law and health law for tailor-made support for all kinds of administrative procedures.

Whether you are a healthcare professional, an employer, or a self-employed worker, we can protect your rights and minimize the financial or disciplinary consequences of disputes with the CPAM. We can, for example, contest overpayments or unjustified sanctions and ensure effective representation before the Social Insurance Section. Thanks to our personalized approach, we will also support you in your compliance efforts to prevent any future risk.

Assistance from our lawyers in litigation with the CPAM: recovery of undue payments or financial penalties

The benefits of Social Security cover a wide range of areas such as health insurance, maternity insurance, occupational accidents, or family benefits. These systems are governed by precise rules aimed at ensuring fair and efficient access to care and assistance. However, in health law, disputes frequently arise around reimbursement of care, particularly when the procedures performed or declared do not comply with applicable standards.

Indeed, healthcare professionals are required to apply the codes and rates set by Social Security while respecting the recommendations of the High Authority for Health and established scientific data. Any failure to comply with these obligations leads to inspections by the Primary Health Insurance Fund (CPAM).

These inspections may cover various elements, such as:

• the regularity of the prescriptions;
• justification of sick leave;
• the compliance of invoiced acts, etc.

In the event of an irregularity found, the CPAM can therefore notify an overpayment and initiate a procedure to recover sums received in error. These situations, although governed by precise procedures, expose practitioners to significant financial and professional risks. Generally, the control leads to a request for a hearing.

It is then recommended to be assisted by your lawyer specializing in disputes with the CPAM for recovery of overpayments or financial penalties. The same applies to proceedings before the Social Insurance Section. This will allow you to protect your rights and try to avoid any notification of overpayment. That is why our law firm offers you complete assistance from the audit. Our experts analyze each element of the audit to identify any errors or misunderstandings in order to prepare reasoned observations.

With their expertise, they can request meetings with the health insurance fund or the medical control department, ensuring you are heard. This will allow you to demonstrate the absence of any breach with the necessary evidence to obtain a cancellation of the overpayment or penalty notice.

Lawyer in litigation with the CPAM: contesting overpayment notifications

Despite the interview following checks carried out by medical advisors, dental surgeons or pharmacy advisors, you may receive a notification of undue payments. In the event of complaints or suspicion of fraud, the CPAM may also send you said notification directly after the checks. These cases require expert defense to avoid heavy financial or disciplinary consequences.

However, you can challenge the notification with our lawyers specializing in disputes with the CPAM for recovery of overpayments or financial penalties. Whether you are a doctor, self-employed nurse, or other healthcare professional, we ensure the protection of your interests in cases of alleged overactivity, double billing, or other alleged anomalies. Whether it is a direct notification or after an interview, our specialists can assist you in building a solid case.

Thanks to their professionalism, you can highlight your evidence and necessary justifications to effectively contest the amounts claimed. Our expertise covers both appeals before the Friendly Appeals Commission (CRA) and litigation before the social division of the judicial court.

At the amicable appeal stage, the challenge is to demonstrate that your actions were fully compliant with regulatory requirements and that any apparent irregularity results from an erroneous interpretation or a particular context. If the amicable appeal fails, our team of professionals in criminal law will represent you before the competent courts.

We will develop tailored strategies to reduce, or even cancel the amounts claimed, while preserving your professional reputation. Finally, we will help you adopt preventive practices to secure your activity and avoid future disputes. This includes advice on billing, documentation of acts, and compliance with legal and regulatory requirements.

Lawyer in disputes with the CPAM: contesting financial penalties and those relating to deconventioning

Since the end of 2020, the Health Insurance has strengthened its control system by introducing the possibility of temporarily suspending the agreement of healthcare professionals in the event of serious breaches.

This measure, initially limited to self-employed healthcare professionals, also applies to:

• health centers;
• pharmacists;
• service providers;
• equipment distributors;
• health transport companies.

It is justified by the need to sanction significant misconduct that has caused substantial financial losses to the Health Insurance system. This suspension, although based on serious facts, must nevertheless comply with a well-defined legal framework. Indeed, the procedure requires that the social security body allow the professional concerned to present their written or oral observations before any decision.

This fundamental right guarantees a fair defense and can allow you to challenge the alleged facts or demonstrate mitigating circumstances. Furthermore, financial penalties may be imposed by the CPAM as a sanction or to repair damages. The amount of the penalties is calculated based on the estimated damage, which can severely affect the professional practice and financial stability of the practitioner concerned.

Here again, the parties accused have the opportunity to file a written challenge. Our firm intervenes at every stage of these complex procedures to ensure the best possible defense. Whether for penalties or deregistration, you can call on our team composed of lawyers specializing in disputes with CPAM for recovery of overpayments or for penalties.

We will assist you in verifying the circumstances surrounding the alleged breaches, gathering the necessary evidence, and preparing written or oral observations. Finally, we develop tailor-made strategies for each situation, ensuring we anticipate the arguments of the Health Insurance and protect your interests. Whether to contest the financial penalty or the decision to de-register, we will do everything possible to obtain a favorable outcome.

Procedure before the Social Insurance Section

The Social Insurance Section is a specific jurisdiction of certain Orders, responsible for the technical litigation of Social Security. Unlike disciplinary chambers, they focus on cases of serious misconduct, faults, abuses, unperformed services, or fraud related to the practice of the profession.

For example, a pharmacist may be penalized for systematically billing non-reimbursable products using falsified prescriptions or for practices that caused harm. The missions of this section, governed by the Public Health Code and the Social Security Code, aim to protect the financial balance of the system while ensuring ethical practice. In this context, we intervene to support not only the professionals under investigation, but also the complaining parties, such as:

• the health insurance funds;
• the regional councils of the Order;
• the regional health agencies;
• the unions;
• the national medical advisor or the regional medical advisors;
• the pluridepartmental chief medical advisors of the medical control.

Our intervention covers all stages of the procedure before the social security section. We assist our clients in collecting and mobilizing evidence, verifying billing items, and developing the necessary arguments for the defense.

During hearings, we plead on behalf of our clients by highlighting the technical and legal aspects that can mitigate their liability or justify the abandonment of sanctions. Our goal is to ensure full representation and effective protection of their rights and professional reputation. Beyond defending professionals, we also advise healthcare system stakeholders on preventing future disputes.

Upstream, we ensure strengthening compliance with professional practices and legal obligations. This may involve explaining Social Security rules and drafting or modifying contracts in the case of clinic-physician relationships. Whatever your situation, you can count on our lawyers.