{"id":657544,"date":"2026-04-23T09:34:38","date_gmt":"2026-04-23T07:34:38","guid":{"rendered":"https:\/\/kohenavocats.com\/cour-dappel-de-douai-le-24-avril-2025-n24-00730\/"},"modified":"2026-04-23T09:34:38","modified_gmt":"2026-04-23T07:34:38","slug":"cour-dappel-de-douai-le-24-avril-2025-n24-00730","status":"publish","type":"post","link":"https:\/\/kohenavocats.com\/zh-hans\/cour-dappel-de-douai-le-24-avril-2025-n24-00730\/","title":{"rendered":"Cour d’appel de Douai, le 24 avril 2025, n\u00b024\/00730"},"content":{"rendered":"
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La cour d’appel de Douai, statuant le 24 avril 2025, a examin\u00e9 le recours d’un infirmier contre une d\u00e9cision de justice. Ce dernier contestait la r\u00e9gularit\u00e9 d’un contr\u00f4le administratif et la notification d’un indu suivi d’une p\u00e9nalit\u00e9 financi\u00e8re. La juridiction a infirm\u00e9 partiellement le premier jugement pour d\u00e9clarer le recours recevable. Elle a finalement rejet\u00e9 l’ensemble des moyens soulev\u00e9s et confirm\u00e9 le bien-fond\u00e9 des sommes r\u00e9clam\u00e9es par la caisse d’assurance maladie.<\/p>\n

La r\u00e9gularit\u00e9 des proc\u00e9dures de contr\u00f4le et de recouvrement<\/p>\n

La cour \u00e9carte d’abord l’application de la charte du contr\u00f4le de l’activit\u00e9. Elle rel\u00e8ve que cette charte “se trouve ainsi d\u00e9pourvue de toute port\u00e9e normative” (Motifs). Son pr\u00e9ambule pr\u00e9cise qu’elle ne saurait se substituer aux textes l\u00e9gislatifs et r\u00e9glementaires. La valeur purement indicative de ce document emp\u00eache donc de fonder sur lui l’annulation de la proc\u00e9dure. La cour rappelle ensuite le caract\u00e8re non juridictionnel du contr\u00f4le administratif. Les garanties du proc\u00e8s \u00e9quitable, comme le droit \u00e0 l’assistance d’un avocat, ne lui sont donc pas attach\u00e9es. Elle constate que le professionnel a \u00e9t\u00e9 inform\u00e9 des anomalies relev\u00e9es et a sign\u00e9 le proc\u00e8s-verbal. Concernant la notification de l’indu, la cour v\u00e9rifie son contenu au regard de l’article R. 133-9-1 du code de la s\u00e9curit\u00e9 sociale. Elle estime que la lettre contest\u00e9e d\u00e9taille suffisamment la p\u00e9riode, les anomalies et les dispositions viol\u00e9es. Elle comporte en annexe “le d\u00e9tail des dossiers en cause” (Motifs) avec la nature et la date de chaque prestation litigieuse. La notification est donc jug\u00e9e r\u00e9guli\u00e8re.<\/p>\n

Le bien-fond\u00e9 des redressements et de la p\u00e9nalit\u00e9<\/p>\n

La cour examine m\u00e9ticuleusement chaque poste de redressement au regard de la nomenclature applicable. Pour les frais de d\u00e9placement, elle s’appuie sur le rapport de l’agent asserment\u00e9 et les questionnaires patients. Elle constate que plusieurs patientes r\u00e9sidaient \u00e0 la m\u00eame adresse et que les soins \u00e9taient prodigu\u00e9s lors d’un seul passage. L’indu est donc maintenu. S’agissant des majorations de nuit, la cour applique l’article 14 de la convention nationale. Elle note l’absence de prescription mentionnant une n\u00e9cessit\u00e9 imp\u00e9rieuse ou d’urgence justifi\u00e9e. Le professionnel ne d\u00e9montre pas le caract\u00e8re urgent des interventions factur\u00e9es avec cette majoration. Pour les actes sans prescription, la cour rappelle l’exigence d’une “prescription m\u00e9dicale \u00e9crite, qualitative et quantitative” (Motifs). Elle \u00e9carte l’argument selon lequel un formulaire de d\u00e9marche de soins tiendrait lieu de prescription, ce document portant une mention contraire. Apr\u00e8s l’analyse de tous les griefs, la cour valide l’int\u00e9gralit\u00e9 de l’indu de 36 961,41 euros. Concernant la p\u00e9nalit\u00e9 financi\u00e8re, la cour v\u00e9rifie le strict respect de la proc\u00e9dure pr\u00e9vue aux articles L. 114-17-1 et R. 147-2. Elle rel\u00e8ve que la commission a \u00e9t\u00e9 saisie dans les d\u00e9lais et que l’avis du directeur g\u00e9n\u00e9ral de l’UNCAM a \u00e9t\u00e9 obtenu. La notification de la p\u00e9nalit\u00e9 est jug\u00e9e suffisamment motiv\u00e9e car elle renvoie au courrier d\u00e9taillant les faits reproch\u00e9s. Eu \u00e9gard \u00e0 la r\u00e9currence et \u00e0 la gravit\u00e9 des anomalies, la p\u00e9nalit\u00e9 de 11 088 euros est estim\u00e9e justifi\u00e9e et proportionn\u00e9e.<\/p>\n

Cet arr\u00eat rappelle avec fermet\u00e9 les exigences proc\u00e9durales et substantielles pesant sur les professionnels de sant\u00e9. Il confirme que la charte de contr\u00f4le, d\u00e9pourvue de valeur normative, ne peut servir de fondement \u00e0 une annulation. La cour d\u00e9limite clairement le champ des garanties applicables, excluant les droits de la d\u00e9fense de type juridictionnel lors d’un contr\u00f4le administratif. Elle rappelle \u00e9galement l’imp\u00e9ratif d’une notification pr\u00e9cise et motiv\u00e9e de l’indu, condition essentielle pour permettre au professionnel de contester utilement. Sur le fond, la d\u00e9cision illustre l’examen rigoureux des r\u00e8gles de facturation et de prise en charge par la juridiction. Elle souligne la charge de la preuve incombant au professionnel pour justifier ses cotations et le respect des prescriptions. En validant la p\u00e9nalit\u00e9 financi\u00e8re, la cour sanctionne les manquements r\u00e9p\u00e9t\u00e9s et graves aux r\u00e8gles conventionnelles. Cet arr\u00eat renforce ainsi les pr\u00e9rogatives de contr\u00f4le des organismes d’assurance maladie tout en encadrant strictement leurs proc\u00e9dures.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

La cour d’appel de Douai, statuant le 24 avril 2025, a examin\u00e9 le recours d’un infirmier contre une d\u00e9cision de justice. Ce dernier contestait la r\u00e9gularit\u00e9 …<\/p>\n","protected":false},"author":232070755,"featured_media":9618,"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,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[7597],"tags":[],"class_list":["post-657544","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jurisprudence"],"yoast_head":"\nCour d'appel de Douai, le 24 avril 2025, n\u00b024\/00730 - Ma\u00eetre Hassan Kohen, avocat en droit p\u00e9nal \u00e0 Paris<\/title>\n<meta name=\"description\" content=\"La cour d'appel de Douai, statuant le 24 avril 2025, a examin\u00e9 le recours d'un infirmier contre une d\u00e9cision de justice. 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