Facts
The appellant, Dr. med. A., is a specialist in General Internal Medicine FMH with a permit to operate a practice pharmacy (self-dispensation) in U. (BE). Various health insurers, represented by the industry association Santésuisse, filed a lawsuit against him with the arbitration tribunal and requested that he be ordered to repay CHF 336,368.- (according to the regression index) or CHF 790,761.- (according to the ANOVA index) for the year 2017 due to uneconomical treatment. The arbitration tribunal upheld the claim and ordered the appellant to reimburse CHF 266,998.40.Considerations
The Federal Supreme Court partially upholds the appeal:- The individual case review as the second part of the economic efficiency review was not fully implemented. The lower court wrongly considered the peculiarity of self-dispensation to be insignificant. Self-dispensation can lead to significantly higher medication costs and possibly also higher treatment costs. This practice-specific feature must be taken into account in the economic…