{"id":18719,"date":"2024-05-31T10:56:32","date_gmt":"2024-05-31T08:56:32","guid":{"rendered":"https:\/\/nandi.info\/?p=18719"},"modified":"2024-05-31T11:01:26","modified_gmt":"2024-05-31T09:01:26","slug":"canam-des-mesures-decisives-pour-lutter-efficacement-contre-la-fraude-a-lamo","status":"publish","type":"post","link":"https:\/\/nandi.info\/?p=18719","title":{"rendered":"CANAM : Adoption de mesures significatives pour contrer de mani\u00e8re efficiente la Fraude \u00e0 l’Assurance Maladie Obligatoire (AMO)"},"content":{"rendered":"\n

La salle de r\u00e9union de la Direction G\u00e9n\u00e9rale de la Caisse Nationale d\u2019Assurance Maladie (CANAM) a \u00e9t\u00e9 le th\u00e9\u00e2tre de deux importantes r\u00e9unions de la commission m\u00e9dicale, ce mercredi 29 mai 2024.<\/strong><\/p>\n\n\n\n

Pr\u00e9sid\u00e9es par le Directeur G\u00e9n\u00e9ral Adjoint de la CANAM, ces s\u00e9ances ont r\u00e9uni divers cadres de l’organisme, ainsi que des repr\u00e9sentants du Conseil National de l\u2019Ordre des M\u00e9decins, de l\u2019Association des M\u00e9decins Lib\u00e9raux du Mali, des syndicats des pharmaciens (SYNAPPO et SYNAPHARM), de l’INPS des cas potentiels de fraude, de faute ou d’abus de prestations au sein de l’Assurance Maladie Obligatoire, impliquant un cabinet m\u00e9dical et une pharmacie.<\/p>\n\n\n\n

Plusieurs aspects ont \u00e9t\u00e9 abord\u00e9s, notamment le contr\u00f4le des prestations dispens\u00e9es dans le cadre du r\u00e9gime d’Assurance Maladie Obligatoire.<\/p>\n\n\n\n

Un point central des d\u00e9bats a \u00e9t\u00e9 l’examen minutieux de quarante-quatre (44) feuilles de soins et des factures soumises par les pharmacies \u00e0 la CMSS pour remboursement. Parmi ces documents, 29 pi\u00e8ces ont suscit\u00e9 des soup\u00e7ons de fraude.<\/p>\n\n\n\n

Les feuilles de soins suspectes avaient \u00e9t\u00e9 prescrites dans divers cabinets et CSREF.<\/p>\n\n\n\n

\u00c0 l’issue des discussions, plusieurs d\u00e9cisions importantes ont \u00e9t\u00e9 prises :<\/p>\n\n\n\n

\u2022 Envoyer une correspondance \u00e0 la CMSS pour rejeter toutes les feuilles de soins irr\u00e9guli\u00e8res identifi\u00e9es dans le rapport, d\u00e9pos\u00e9es par la pharmacie concern\u00e9e pour remboursement, sans pr\u00e9judice de poursuites judiciaires ;<\/p>\n\n\n\n

\u2022 Informer la pharmacie de la d\u00e9cision de la CANAM concernant la gestion de ses irr\u00e9gularit\u00e9s ;<\/p>\n\n\n\n

\u2022 Envoyer une lettre d\u2019avertissement au pharmacien, soulignant sa responsabilit\u00e9 dans cette affaire ;<\/p>\n\n\n\n

\u2022 Supprimer les trois codes prescripteurs impliqu\u00e9s dans des cas de faux et usage de faux ;<\/p>\n\n\n\n

\u2022 Adresser une lettre de suspension de la convention au responsable du cabinet concern\u00e9 pour fraude, complicit\u00e9 de fraude et tentative de corruption du m\u00e9decin contr\u00f4leur, jusqu\u2019\u00e0 nouvel ordre.<\/p>\n\n\n\n

Ces d\u00e9cisions refl\u00e8tent la d\u00e9termination de la CANAM \u00e0 maintenir l’int\u00e9grit\u00e9 et la transparence de son syst\u00e8me de gestion de l’Assurance Maladie Obligatoire, et \u00e0 prendre des mesures rigoureuses contre toute tentative de fraude ou d’abus.<\/p>\n\n\n\n

SERCOM\/CANAM<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

La salle de r\u00e9union de la Direction G\u00e9n\u00e9rale de la Caisse Nationale d\u2019Assurance Maladie (CANAM) a \u00e9t\u00e9 le th\u00e9\u00e2tre de deux importantes r\u00e9unions de la commission m\u00e9dicale, ce mercredi 29…<\/p>\n","protected":false},"author":1,"featured_media":18720,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"content-type":"","_lmt_disableupdate":"","_lmt_disable":"","_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[43,21],"tags":[],"class_list":["post-18719","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nandi-info","category-societe"],"jetpack_publicize_connections":[],"featured_image_urls":{"full":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1280,960,false],"thumbnail":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan-150x150.jpg",150,150,true],"medium":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan-300x225.jpg",300,225,true],"medium_large":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan-768x576.jpg",768,576,true],"large":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan-1024x768.jpg",1024,768,true],"1536x1536":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1280,960,false],"2048x2048":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1280,960,false],"penci-recipe-1200x1200":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1200,900,false],"penci-recipe-1200x900":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1200,900,false],"penci-recipe-1200x675":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",900,675,false],"penci-single-full":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1280,960,false],"penci-slider-full-thumb":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1067,800,false],"penci-full-thumb":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",1170,878,false],"penci-slider-thumb":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",884,663,false],"penci-magazine-slider":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",688,516,false],"penci-thumb":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",520,390,false],"penci-masonry-thumb":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",585,439,false],"penci-thumb-square":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",585,439,false],"penci-thumb-vertical":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",480,360,false],"penci-thumb-small":["https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg",233,175,false]},"author_info":{"display_name":"Nandi","author_link":"https:\/\/nandi.info\/?author=1"},"category_info":"Nandi.info<\/a> Soci\u00e9t\u00e9<\/a>","tag_info":"Soci\u00e9t\u00e9","comment_count":"0","jetpack_featured_media_url":"https:\/\/nandi.info\/wp-content\/uploads\/2024\/05\/canam-abijan.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/posts\/18719","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nandi.info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18719"}],"version-history":[{"count":2,"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/posts\/18719\/revisions"}],"predecessor-version":[{"id":18723,"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/posts\/18719\/revisions\/18723"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nandi.info\/index.php?rest_route=\/wp\/v2\/media\/18720"}],"wp:attachment":[{"href":"https:\/\/nandi.info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18719"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nandi.info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18719"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nandi.info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18719"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}