{"id":665933,"date":"2026-04-24T00:40:10","date_gmt":"2026-04-23T22:40:10","guid":{"rendered":"https:\/\/kohenavocats.com\/tribunal-judiciaire-de-saint-denis-de-la-reunion-le-24-septembre-2025-n24-00151\/"},"modified":"2026-04-24T00:40:10","modified_gmt":"2026-04-23T22:40:10","slug":"tribunal-judiciaire-de-saint-denis-de-la-reunion-le-24-septembre-2025-n24-00151","status":"publish","type":"post","link":"https:\/\/kohenavocats.com\/ru\/tribunal-judiciaire-de-saint-denis-de-la-reunion-le-24-septembre-2025-n24-00151\/","title":{"rendered":"Tribunal judiciaire de Saint-Denis de la R\u00e9union, le 24 septembre 2025, n\u00b024\/00151"},"content":{"rendered":"
\n

Le tribunal judiciaire de Saint-Denis de la R\u00e9union, le 24 septembre 2025, statue sur un litige entre un professionnel de sant\u00e9 et un organisme d’assurance maladie. L’organisme a notifi\u00e9 un indu au professionnel pour d\u00e9faut de transmission r\u00e9guli\u00e8re des prescriptions m\u00e9dicales. Le tribunal, apr\u00e8s avoir joint les recours et constat\u00e9 leur recevabilit\u00e9, confirme le principe de l’indu et en r\u00e9duit le montant. Il condamne finalement le professionnel au paiement de la somme recalcul\u00e9e et aux d\u00e9pens.<\/p>\n

Le formalisme imp\u00e9ratif de la prescription m\u00e9dicale<\/p>\n

La d\u00e9cision rappelle d’abord les conditions l\u00e9gales de prise en charge par l’assurance maladie. Le remboursement des actes est subordonn\u00e9 \u00e0 leur inscription sur une liste pr\u00e9vue par le code. «L’inscription sur la liste peut elle-m\u00eame \u00eatre subordonn\u00e9e au respect d’indications th\u00e9rapeutiques ou diagnostiques, \u00e0 l’\u00e9tat du patient ainsi qu’\u00e0 des conditions particuli\u00e8res de prescription» (article L. 162-1-7 du code de la s\u00e9curit\u00e9 sociale). Le cadre l\u00e9gal impose ainsi un strict respect des modalit\u00e9s de prescription pour la prise en charge.<\/p>\n

L’exigence d’une prescription dat\u00e9e constitue le c\u0153ur du formalisme contr\u00f4l\u00e9. Le texte applicable pr\u00e9cise les mentions obligatoires que doit porter l’ordonnance. «L’ordonnance, lorsqu’elle existe, doit comporter les \u00e9l\u00e9ments suivants. Le prescripteur y fait mention, quel que soit le support : [\u2026] De la date \u00e0 laquelle elle est faite» (article R. 161-45, I, du code de la s\u00e9curit\u00e9 sociale). Cette formalit\u00e9 est essentielle pour permettre le rapprochement avec la feuille de soins et v\u00e9rifier la r\u00e9gularit\u00e9 des actes factur\u00e9s.<\/p>\n

Les cons\u00e9quences proc\u00e9durales d’une transmission irr\u00e9guli\u00e8re<\/p>\n

Le manquement aux r\u00e8gles de transmission entra\u00eene une sanction financi\u00e8re directe. La d\u00e9cision applique le dispositif l\u00e9gal de r\u00e9cup\u00e9ration des indus. «lorsque le professionnel de sant\u00e9 a transmis, hors du d\u00e9lai pr\u00e9vu […] les ordonnances correspondant aux feuilles de soins \u00e9lectroniques, l’organisme d’assurance maladie peut exiger de ce dernier la restitution de tout ou partie des prestations servies \u00e0 l’assur\u00e9» (article L. 161-33, alin\u00e9as 1 et 3). Ce principe juridique est ainsi strictement mis en \u0153uvre contre le professionnel d\u00e9faillant.<\/p>\n

En l’esp\u00e8ce, l’alt\u00e9ration de la date sur les documents scann\u00e9s est fatale. Le professionnel reconna\u00eet avoir communiqu\u00e9 des prescriptions dont la date \u00e9tait tronqu\u00e9e. Les pi\u00e8ces produites ult\u00e9rieurement sont jug\u00e9es insuffisantes pour \u00e9tablir la correspondance avec les documents initiaux. Seule la r\u00e9gularisation partielle accept\u00e9e par la caisse, concernant une prescription dont la date \u00e9tait simplement masqu\u00e9e, permet une mod\u00e9ration de l’indu. La charge de la preuve p\u00e8se ainsi int\u00e9gralement sur le professionnel pour d\u00e9montrer la r\u00e9gularit\u00e9 de sa facturation.<\/p>\n

Cette d\u00e9cision illustre la rigueur exig\u00e9e dans la gestion des feuilles de soins \u00e9lectroniques. Elle rappelle que la date de la prescription est une mention substantielle dont l’alt\u00e9ration, m\u00eame involontaire, est sanctionn\u00e9e. Le juge op\u00e8re un contr\u00f4le strict de la preuve apport\u00e9e par le professionnel pour contester l’indu. La solution s’inscrit dans la lign\u00e9e d’une jurisprudence exigeante sur les conditions de prise en charge. «Il r\u00e9sulte de la combinaison de ces textes que la prise en charge par l’assurance maladie des actes effectu\u00e9s personnellement par un masseur-kin\u00e9sith\u00e9rapeute implique que ceux-ci aient fait l’objet, ant\u00e9rieurement \u00e0 l’engagement des soins, d’une prescription m\u00e9dicale \u00e9crite mentionnant, quel que soit le support, la date \u00e0 laquelle elle est faite» (Cass. Deuxi\u00e8me chambre civile, le 9 septembre 2021, n\u00b020-17.137). La port\u00e9e de l’arr\u00eat est donc pr\u00e9ventive, incitant \u00e0 une parfaite r\u00e9gularit\u00e9 documentaire.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Le tribunal judiciaire de Saint-Denis de la R\u00e9union, le 24 septembre 2025, statue sur un litige entre un professionnel de sant\u00e9 et un organisme d’assurance m…<\/p>\n","protected":false},"author":232070755,"featured_media":9553,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_kj_source_type":"judilibre","_kj_official_id":"68dd599e548223b2c7a72cc5","_kj_official_url":"https:\/\/www.courdecassation.fr\/decision\/68dd599e548223b2c7a72cc5","_kj_judilibre_id":"68dd599e548223b2c7a72cc5","_kj_jur":"Tribunal judiciaire","_kj_lieu":"Tribunal judiciaire de Saint-Denis de La R\u00e9union","_kj_chambre":"CTX PROTECTION SOCIALE","_kj_rg":"24\/00151","_kj_date":"2025-09-24","_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[7597],"tags":[],"class_list":["post-665933","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jurisprudence"],"yoast_head":"\nTribunal judiciaire de Saint-Denis de la R\u00e9union, le 24 septembre 2025, n\u00b024\/00151 - 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