Facts
On March 9/22, 2012, Clinic A. AG and 48 health insurers concluded a tariff agreement pursuant to the Health Insurance Act (KVG) (SwissDRG) on the remuneration of services according to SwissDRG for acute inpatient treatment. On September 23, 2015, 17 of the tariff agreement health insurers filed a lawsuit against Clinic A. AG for "tariff dispute (claim for reimbursement of unlawful additional costs following tariff change, CMI case monitoring)" with the legal claim that Clinic A. AG be ordered to pay a total of CHF 200,712.40 to the plaintiff health insurers.
The arbitration tribunal in social insurance matters of the Canton of Solothurn fully upheld the claim. Clinic A. AG subsequently filed an appeal in public law matters with the Federal Supreme Court.
Considerations
The Federal Supreme Court first establishes that the arbitration tribunal was competent to adjudicate the dispute between the parties.
On the merits, the Federal Supreme Court states that the new hospital financing since January 1, 2009 brought a change in the tariff model to performance-related flat rates. The tariff partners also had to agree on accompanying measures such as monitoring and correction mechanisms. Since this was not achieved, the Federal Council issued corresponding regulations in the final provisions of the Health Insurance Ordinance (KVV).
According to these provisions, the service provider must, in the first two years after the introduction of the new remuneration model, make a proportional repayment of the additional revenue in the event of an unjustified increase in the actual number of cases by more than 2% compared to the number of cases taken into account in the agreement of…