Reimbursement of Medication Costs in Case of Uneconomical Treatment

Facts

This judgment addresses the question of whether, in the context of the reimbursement of fees for uneconomical medical treatment, the medication costs incurred by the physician can also be taken into account. The appellant, a physician, objects to the health insurers' demand for reimbursement of these costs.

The lower court had taken into account the incurred medication costs when determining the amount to be reimbursed. The appellant argues that this is contrary to federal law, as Art. 56 para. 2 of the Health Insurance Act (KVG) expressly refers only to the reimbursement of the unjustly paid fees, but not to the incurred costs that were directed to other service providers such as pharmacies.

Considerations

The Federal Supreme Court dismisses the appeal. It explains that the essence of Art. 23 of the Federal Health Insurance Act (KUVG), which regulated the principle of economic treatment, has been incorporated unchanged into Art. 56 of the KVG. This principle extends not only to the services personally provided by the physician, but also to his orders that result in services provided by third parties such as pharmacies.

Therefore, it is…