Facts
The subject matter of the dispute concerns the appellant's obligation to reimburse fees for the years 2013 and 2014 based on Article 59 paragraph 1 letter b of the Federal Health Insurance Act (KVG) due to a violation of the requirement of cost-effectiveness of services under Article 56 paragraph 1 KVG.
The cantonal arbitration tribunal examined the cost-effectiveness of the appellant's practice activity by applying the statistical method of analysis of variance (ANOVA). This resulted in an amount of CHF 33,303.20 for 2013 and CHF 40,204.50 for 2014 that had to be reimbursed.
The appellant disputes the applicability of a statistical method and instead demands an individual case examination (analytical method).
Considerations
According to the new paragraph inserted into Article 56 paragraph 6 KVG by the Federal Act of December 23, 2011, service providers and insurers contractually determine a method for controlling cost-effectiveness. In a contract dated December 27, 2013/January 16, 2014, FMH, santésuisse and curafutura agreed on analysis of variance (ANOVA) as the statistical method.
The cantonal arbitration tribunal correctly recognized that Article 56 paragraph 6 KVG does not generally exclude the application of the ANOVA method. The legislator wanted to…