The Cnam and the order of doctors attack the site Arretmaladie.com

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The launch of the website www.arretmaladie.com, which feeds the controversy on social networks, was formalized Tuesday, January 7 by a press release.

The service is presented as the declination of the German website au-schein.com, launched in December 2018 by Can Hansay, a lawyer from Hamburg, and who claims to have generated "30,000 sick leaves for so-called everyday pathologies".

"After a teleconsultation with a French doctor and subject to being able to make a reliable diagnosis, the patient can get a sick leave of a few days (2 to 3 max) for simple and common pathologies: cold spell, stress, menstrual pain, gastroenteritis, etc. ", it said in the press release.

On the website, there are several catchphrases, such as "sick leave without traveling", "100% valid", "reimbursable" and "fast and secure", accompanied by a ehealth explaining the process proclaiming "it's my law".

The user must first choose from 7 situations (2 of which are currently functional: gastroenteritis and "cold snap"), then complete a health questionnaire (symptoms, history, medical information), before being referred to a teleconsultation platform, and / or receive a ehealth call from a doctor.

The latter then decides whether or not to prescribe a work stoppage "of a maximum duration of 2 to 3 days" (within the limit of 4 stoppages per year per patient), deposited in the form of PDF file in a secure online space, that the internet user recovers after having paid the cost of an online consultation, ie 25 euros, it is up to him to send the notice of termination to his employer and to his health insurance fund.

If the site says that these stop prescriptions are "reimbursable" in theory, it is content to recall the applicable regulatory framework, and indicates that it depends on "the usual rules for respecting the coordinated care pathway".

The "DocteurSécu" telemedicine platform (www.docteursecu.com), whose head office is based in Marseille, and which is the subject of an authorization by the regional health agency (ARS) Paca "via an ongoing telemedicine contract", is presented as "partner" of the site and in charge of managing the forms.

In a press release issued Sunday, DocteurSécu officials, Dr Jacques Durand and Loïc Petitprez, confirm this partnership but seem to distance themselves from certain assertions relayed on Arretmaladie.com. They claim to have no "commercial or legal agreement" with the company of Can Hasay, and indicate that their company takes part in the "experimentation" that it offers through this site.

Refusing to take "responsibility for site publications www.arretmaladie.com which is not (their) responsibility ", they consider it to be a" purely informative mini-site "which" simply offers to refer patients who are looking for a way to rest for health reasons towards a French telemedicine platform ".

They also argue that "short-term sick leave of 1 to 3 days in telemedicine" constitutes "a necessity in the face of a health emergency", in particular to "unclog emergencies" and avoid the risk of contamination during an epidemic flu and gastroenteritis.

They also ensure that "at no time does the service guarantee the automatic issuance of a work stoppage".

The site does not meet the conditions necessary for reimbursement

Solicited on January 7 by APMnews (site of the international APM group, of which TICsanté is a part), the Cnam said at first that it had been "alerted to the existence of this site, the promotional communication of which seems both untrue in its content and criticizable in principle "and consider" the necessary legal initiatives ".

At the end of the day, it announced in a press release that it was going to "put the site to notice immediately to cease its activities and also initiate, to this end, an action for interim measures".

"This site conveys inaccurate information that misleads the insured and deviates from medical ethics," said the fund in its press release.

It "wishes to alert policyholders to the fact that taking charge of teleconsultation health insurance calls for compliance with a certain number of conditions, which are not fulfilled when using this site".

"It is ethically open to criticism to promote an online medical consultation site on the basis of the promise of facilitated obtaining of a work stoppage", then observes the CNAM, stressing that work stoppages "are not not consumer products, which can be distributed at the request of patients. "

"In this sense, the procedures for requesting and obtaining a work stoppage provided by this site appear to be contrary to the recommendations of good practice issued by the competent authorities," said Cnam.

Asked about RTL on January 8, the director of Cnam, Nicolas Revel, said that this site "deceives the insured", his consultations not being reimbursed by health insurance.

This "ethical drift" encourages us to "reflect on the evolution of our legislation on the conditions of prescription and issuance of work stoppages". "We will see according to the court decision," he added.

The order of doctors "firmly condemns" the site

In a statement sent the same day, the order of doctors "firmly condemns" the site and its "deceptive and mercantile practices".

He "immediately gives notice to the site to cease its activities" and announces that he "will initiate an action for interim measures in the very next days" in connection with the Cnam, which confirmed Nicolas Revel on RTL.

"If the order of doctors is resolutely placed in a dynamic of support for the new paths offered by e-health, it unreservedly condemns any attempt to uberize medicine", said the president of the Cnom, Patrick Bouet .

In January 2019, Nicolas Revel had put an end to the reimbursement of teleconsultation procedures carried out by professionals from the CNP health center and Créteil teleconsultations, whose managing association is DigiSanté and the technological provider, the Livi platform.

Health insurance considered that the organizational arrangements for these teleconsultations did not meet the care framework defined by endorsement No. 6 of the medical agreement.

The Council of State had rejected in interim measures a request to suspend this decision in May 2019. The case is still being examined on the merits before the Council of State, we learned on January 7 from high jurisdiction.

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