I. In order to improve the link between the public and private sectors, AFA announces the continuation of its controls in the healthcare sector.
In October 2024, AFA published a guide for public healthcare establishments in light of its findings from its former controls. More recently, at its first “Rendez-vous de l’AFA” event on the monitoring of corporate anti-corruption measures, AFA announced that it would be scheduling controls of companies in the healthcare sector.
A. AFA publishes a guide to preventing corruption in hospitals following audits in the healthcare sector.
In October 2024, AFA published a guide for public healthcare establishments on setting up or updating anti-corruption systems.[1] The healthcare sector raises a number of social and economic issues which justify raising awareness among professionals of the risks of corruption.[2] This guide comes in the wake of audits carried out in France, which revealed that “French anti-corruption standards in healthcare establishments are still in need of improvement”. Its aim is to raise awareness of the risk of corruption among healthcare professionals.[3]
Exposure to the risk of corruption in the healthcare sector can be explained by the sums of money involved, the importance of public procurement, emergency situations, the specific structure of competition and, lastly, the links of interest between public and economic players.[4]
In particular, the activities of healthcare establishments are based on complex partnerships between public and private participants, and mainly between healthcare establishment professionals and companies producing or marketing healthcare products. The challenge of this collaboration is to maintain a balance between the public interest and the economic objectives of private players, in order to preserve the integrity of the healthcare system and avoid conflicts or illegal interests.[5]
With this guide, AFA recalls the fundamentals of the governing body’s commitment to ethics and compliance, as well as the importance of risk mapping and the implementation of a structured system for preventing, detecting and punishing breaches of integrity.[6]
The guide includes concrete case studies for professionals, illustrating the specific risks that organizations may face, in particular those linked to public procurement, gifts and invitations, relations with companies whose products are covered by the Social Security system, and interactions with local authorities and service associations.[7]
B. AFA announces the launch of a wave of controls on companies in the healthcare sector.
On 10 February 2025, AFA organized the first edition of its “Rendez-vous de l’AFA” conference on corporate anti-corruption controls. This conference provided an opportunity to share the results and lessons learned from the 129 controls carried out by AFA since its creation.[8] A number of areas for improvement were identified, including the structuring of anti-corruption governance, the development of accurate and appropriate risk mapping, and the monitoring and evaluation of systems.[9]
This conference enabled AFA to share its new outlook for 2025, both in terms of control methodology and the sectors targeted by future controls, including the healthcare sector.[10]
The scheduling of controls in this sector has been described as a priority, although not an exclusive one.[11] Indeed, in accordance with the guide published in October 2024, AFA considers that this is a sector with significant social stakes and therefore wishes to ensure that the sector’s major production and marketing companies have effective compliance programs in place within the framework of the Sapin II Act.[12]
II. The healthcare sector is particularly exposed to breaches of integrity.
On 10 February 2025, the Paris Criminal Court opened proceedings against a company specializing in the marketing of respiratory assistance services, on suspicion of offering hidden advantages. This trial is not isolated as other cases within the healthcare industry also made the headlines these last years.
A. AMS suspected of offering gifts and benefits to doctors.
On 10 February 2025, AMS went on trial before the Paris Criminal Court. This company, which markets respiratory assistance services, is suspected of having spent almost 6 million euros between 2010 and 2014 on hidden benefits for doctors,[13] thereby circumventing anti-gift laws.[14] The former CEO and CFO of AMS who were prosecuted for “complicity in the illicit offer or provision of benefits”[15] were finally sentenced on 5 May 2025, to fines of €300,000 and €150,000, respectively, along with a five-year suspended ban on holding a financial position for the former CFO.[16] A pneumologist who was also prosecuted for “illicitly receiving benefits from a company whose products or services are reimbursed by Social Security”[17] was sentenced to a fine of €15,000.[18] These three individuals will have to pay €12,000 to the French Medical Association,[19] which had brought a civil action.[20]
Twelve other people involved in this case, including six doctors and five former AMS executives, have already been sentenced in 2024 to fines ranging from 10,000 to 200,000 euros as part of a plea bargaining.[21]
Through false invoices and expense claims, AMS offered gifts and benefits to doctors who prescribed respiratory assistance equipment on behalf of AMS, leading to claims for reimbursement by the French Social Security system. According to the Paris public prosecutor’s office, the company had institutionalized this “bonus policy”, devoting up to 4% of its sales to it.[22]
B. The national and international healthcare sector has recently been confronted with breaches of integrity
In October 2024, former Health Minister Agnès Firmin Le Bodo was convicted of accepting undeclared gifts from Urgo laboratories, worth a total of 20,000 euros, when she was a pharmacist. For its part the laboratories received a 1.125 million euros fine.[23] These gifts included luxury watches, bottles of wine and weekend gift sets, received between 2015 and 2020.[24] These two convictions were each part of a plea-bargaining, for which the sentences were negotiated and homologated by an independent judge.[25]
From an international perspective, in September 2018, the Securities and Exchange Commission (“SEC”) announced that Sanofi – a French company – had agreed to pay more than 25 million dollars to obtain the dismissal of lawsuits brought against it in connection with bribe payments made by its subsidiaries in Kazakhstan and the Middle East, which were aimed at obtaining contracts and increasing prescriptions for its products.[26] As part of this agreement, the U.S. Department of Justice (“DOJ”) has decided not to bring charges against Sanofi, which does not acknowledge these accusations, but has announced that it is strengthening internal controls and anti-corruption programs.[27]
Also, in February 2020, Sanofi agreed to pay $11.85 million in connection with allegations that it had violated the False Claims Act by paying kickbacks to Medicare patients through an allegedly independent charitable foundation.[28]
The controls announced by AFA will therefore aim to ensure that French companies in the healthcare sector have effective systems in place to reduce the risk of breaches, both in France and abroad, linked to breaches of integrity.
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