Facts
The [A. AG] had improperly billed the emergency inconvenience flat rate F (TARMED tariff item 00.2505) over an extended period of time. Several health insurers subsequently filed a lawsuit against [A. AG] and demanded the repayment of at least CHF 1,144,231.26 for services that were overbilled during the period from January 1, 2016 onwards. The arbitration tribunal partially upheld the claim and ordered [A. AG] to repay CHF 1,040,377.56. [A. AG] then filed an appeal in public law matters.Considerations
1. The Federal Court examines whether the health insurers' right to reclaim was partially forfeited. The decisive factor is when the health insurers gained sufficient knowledge of the unlawful billing practices of [A. AG] . 2. The arbitration tribunal found that the health insurers recognized the problem of the unlawful billings in July 2020 and received the basis for the reclaim calculation in March and May 2021 respectively. From these points in time, the so-called "second occasion" had occurred, which triggered the start of the relative limitation period. The filing of the conciliation request on May 11, 2021 had therefore been made in a timely manner. 3. The Federal Court confirms the findings of…