{ "article": { "LEGIARTI000006759821": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "11", "TYPE": "ENTIEREMENT_MODIF", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2999-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000006759821", "URL": "article/LEGI/ARTI/00/00/06/75/98/LEGIARTI000006759821.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSFAAPXXXXX011AXXXXXXXAA" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000006742465", "@num": "L315-2", "#text": "Code de la sécurité sociale. - art. L315-2 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CREATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742471", "@num": "L315-3", "#text": "Code de la sécurité sociale. - art. L315-3 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CREATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006106411", "@fin": "2999-01-01", "#text": "TITRE IV : Systèmes d'information de l'assurance maladie et cartes de santé.", "@debut": "1996-04-25" } ] }, "@cid": "JORFTEXT000000192992", "@nor": "TASX9600042R", "@num": "96-345", "@nature": "ORDONNANCE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Ordonnance no 96-345 du 24 avril 1996 relative à la maîtrise médicalisée des dépenses de soins", "@debut": "2999-01-01", "@id_txt": "JORFTEXT000000192992", "@c_titre_court": "Ordonnance n°96-345 du 24 avril 1996" }, { "@fin": "2999-01-01", "#text": "Ordonnance n° 96-345 du 24 avril 1996 relative à la maîtrise médicalisée des dépenses de soins", "@debut": "1996-04-25", "@id_txt": "LEGITEXT000005620824", "@c_titre_court": "Ordonnance n° 96-345 du 24 avril 1996" } ], "@ministere": "MINISTERE DU TRAVAIL ET DES AFFAIRES SOCIALES", "@date_publi": "1996-04-25", "@date_signature": "1996-04-24" } }, "VERSIONS": { "VERSION": [ { "LIEN_ART": { "@id": "LEGIARTI000006759821", "@fin": "2999-01-01", "@num": "11", "@debut": "2999-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "a modifié les dispositions suivantes
\n
" } }, "LEGIARTI000006742465": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2001-12-26", "DATE_DEBUT": "1996-04-25" } }, "META_COMMUN": { "ID": "LEGIARTI000006742465", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742465.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L02AXXAA" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000006759821", "@num": "11", "#text": "Ordonnance n°96-345 du 24 avril 1996 - art. 11 () JORF 25 avril 1996", "@sens": "source", "@cidtexte": "JORFTEXT000000192992", "@nortexte": "TASX9600042R", "@numtexte": "96-345", "@typelien": "CREATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-04-24" }, { "@id": "LEGIARTI000046813093", "@num": "20-5-6", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - art. 20-5-6 (VD)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000006684619", "@num": "124", "#text": "Décret n°2003-1010 du 22 octobre 2003 - art. 124 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000610356", "@nortexte": "SOCA0323026D", "@numtexte": "2003-1010", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2003-10-22" }, { "@id": "LEGIARTI000006726174", "@num": "35", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 35 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000026930574", "@num": "Annexe", "#text": "Arrêté du 21 juin 2006 - art. Annexe (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000609522", "@nortexte": "SANS0622624A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2006-06-21" }, { "@id": "LEGIARTI000006252691", "@num": "3", "#text": "Arrêté du 26 juin 2006 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000792699", "@nortexte": "SANS0622660A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2006-06-26" }, { "@id": "LEGIARTI000006760041", "@num": "83", "#text": "Ordonnance n° 2006-1588 du 13 décembre 2006 - art. 83 (VT)", "@sens": "cible", "@cidtexte": "JORFTEXT000000616196", "@nortexte": "SANX0600142R", "@numtexte": "2006-1588", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "2006-12-13" }, { "@id": "LEGIARTI000029736056", "#text": "ARRÊTÉ du 27 octobre 2014 - art. (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000029735834", "@nortexte": "AFSS1425785A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2014-10-27" }, { "@id": "LEGIARTI000030458287", "@num": "1", "#text": "DÉCRET n°2015-391 du 3 avril 2015 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000030456722", "@nortexte": "AFSS1428496D", "@numtexte": "2015-391", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2015-04-03" }, { "@id": "LEGIARTI000033343923", "#text": "Décret n°2016-1494 du 4 novembre 2016 - art. (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000033342215", "@nortexte": "AFSS1626934D", "@numtexte": "2016-1494", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2016-11-04" }, { "@id": "LEGITEXT000037138681", "#text": "Décret n°2018-557 du 30 juin 2018 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000037132316", "@nortexte": "SSAS1816711D", "@numtexte": "2018-557", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2018-06-30" }, { "@id": "LEGITEXT000037258085", "#text": "Décret n°2018-661 du 26 juillet 2018 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000037256925", "@nortexte": "SSAS1816707D", "@numtexte": "2018-661", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2018-07-26" }, { "@id": "LEGIARTI000050506990", "@num": "R314-122", "#text": "Code de l'action sociale et des familles - art. R314-122 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006074069", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000037138716", "@num": "D315-5", "#text": "Code de la sécurité sociale. - art. D315-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006736472", "@num": "D323-3", "#text": "Code de la sécurité sociale. - art. D323-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000038622128", "@num": "D613-27", "#text": "Code de la sécurité sociale. - art. 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L613-13 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "TXT_ASSOCIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743597", "@num": "L615-13", "#text": "Code de la sécurité sociale. - art. L615-13 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743597", "@num": "L615-13", "#text": "Code de la sécurité sociale. - art. L615-13 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "TXT_ASSOCIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844912", "@num": "R147-6", "#text": "Code de la sécurité sociale. - art. R147-6 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844852", "@num": "R147-8", "#text": "Code de la sécurité sociale. - art. R147-8 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000047502404", "@num": "R147-9-2", "#text": "Code de la sécurité sociale. - art. R147-9-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048630417", "@num": "R161-48", "#text": "Code de la sécurité sociale. - art. R161-48 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000050670554", "@num": "R162-20-5-1", "#text": "Code de la sécurité sociale. - art. R162-20-5-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000043413468", "@num": "R162-52-1", "#text": "Code de la sécurité sociale. - art. R162-52-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749191", "@num": "R315-1-3", "#text": "Code de la sécurité sociale. - art. R315-1-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006585500", "@num": "L732-5", "#text": "Code rural - art. L732-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071367", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006580926", "@num": "1106-2", "#text": "Code rural ancien - art. 1106-2 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071366", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006156082", "@fin": "2999-01-01", "#text": "Chapitre 5 : Contrôle médical", "@debut": "1996-04-25" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141616", "@fin": "2999-01-01", "#text": "Titre I : Généralités", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126889", "@fin": "2999-01-01", "#text": "Livre III : Dispositions relatives aux assurances sociales et à diverses catégories de personnes rattachées au régime général", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106050", "@fin": "2999-01-01", "#text": "Partie législative", "@debut": "1985-12-21" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742465", "@fin": "2001-12-26", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742466", "@fin": "2003-12-19", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2001-12-26", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742467", "@fin": "2004-08-17", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2003-12-19", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742468", "@fin": "2007-12-22", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000017844895", "@fin": "2008-12-19", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2007-12-22", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000019954048", "@fin": "2016-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2008-12-19", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000031687215", "@fin": "2018-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2016-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000036393651", "@fin": "2019-12-28", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2018-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000045065557", "@fin": "2021-07-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2019-12-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000042686005", "@fin": "2021-12-25", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2021-07-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000045065602", "@fin": "2022-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2021-12-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000041398082", "@fin": "2023-12-28", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2022-01-01", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000048687768", "@fin": "2999-01-01", "@num": "L315-2", "@etat": "VIGUEUR", "@debut": "2023-12-28", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
Les avis rendus par le service du contrôle médical portant sur les éléments définis au I de l'article L. 315-1 s'imposent à l'organisme de prise en charge.
\n
Si, indépendamment des dispositions particulières qui subordonnent le bénéfice de certaines prestations à l'accord préalable de l'organisme de prise en charge, le service du contrôle médical estime qu'une prestation mentionnée à l'article L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré, en suspend le service. Les contestations d'ordre médical portant sur cette décision donnent lieu à l'expertise médicale mentionnée à l'article L. 141-1.
" } }, "LEGIARTI000006742471": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-3", "ETAT": "ABROGE", "TYPE": "AUTONOME", "DATE_FIN": "2002-12-24", "DATE_DEBUT": "1996-04-25" } }, "META_COMMUN": { "ID": "LEGIARTI000006742471", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742471.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L03AXXAA" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000006759821", "@num": "11", "#text": "Ordonnance n°96-345 du 24 avril 1996 - art. 11 () JORF 25 avril 1996", "@sens": "source", "@cidtexte": "JORFTEXT000000192992", "@nortexte": "TASX9600042R", "@numtexte": "96-345", "@typelien": "CREATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-04-24" }, { "@id": "LEGIARTI000006790683", "@num": "2", "#text": "Arrêté du 6 mars 1997 - art. 2 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000198384", "@nortexte": "TASS9720731A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "1997-03-06" }, { "@id": "LEGIARTI000006791258", "@num": "Annexe II", "#text": "Arrêté du 10 juillet 1998 - art. 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En cas de non-respect des règles d'établissement des feuilles de soins et des ordonnances destinées aux assurés reconnus atteints d'affections relevant des dispositions de l'article L. 324-1, en cas de non-respect des règles de prescription de médicaments définies à l'article L. 162-4, de non-respect des conditions de prise en charge des frais de transport visés au 2° de l'article L. 321-1 ou de non-respect des conditions prévues pour l'attribution des indemnités visées au 5° du même article, le service du contrôle médical saisit un comité médical régional composé de deux représentants désignés en son sein par la section correspondante de l'union des médecins exerçant à titre libéral, de deux médecins conseils désignés par le service régional du contrôle médical et du médecin inspecteur régional, ou de son représentant, qui en assure la présidence. Ce comité se prononce sur la matérialité des faits et les sanctions financières susceptibles d'être prises à l'encontre de l'auteur des actes ou des prescriptions irrégulières, dans des conditions fixées par décret en Conseil d'Etat.
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L'avis rendu par le comité médical s'impose à la caisse et au professionnel concerné. Le montant des sanctions peut aller jusqu'au remboursement à la caisse de la dépense supportée par elle, au titre des actes et des prescriptions irréguliers.
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La mise en oeuvre de ces sanctions ne fait pas obstacle à l'application des mesures pouvant être prises à l'égard du bénéficiaire de la prestation concernée, conformément au deuxième alinéa de l'article L. 315-2.
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Par dérogation aux dispositions de l'article L. 145-1, les litiges nés de l'application de ces dispositions sont portés devant les juridictions du contentieux général de la sécurité sociale.
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Article 11 ENTIEREMENT_MODIF (Ordonnance no 96-345 du 24 avril 1996 relative à la maîtrise médicalisée des dépenses de soins)