Reclaiming Fees for Uneconomical Treatment

Facts

On 15 July 2008, 47 health insurers filed a claim with the Arbitration Tribunal of the Canton of Appenzell Ausserrhoden against Dr. med. A., a specialist in ophthalmology FMH. They demanded that Dr. med. A. reimburse them a portion of his annual revenue for 2006. The Arbitration Tribunal partially upheld the claim and obliged Dr. med. A. to repay CHF 520,423.60 to the health insurers. Dr. med. A. subsequently filed a complaint with the Federal Supreme Court.

Considerations

The Federal Supreme Court held that for reclaiming fee demands due to uneconomical treatment after 23 February 2005, Art. 59 para. 1 let. b HIA, and no longer Art. 56 para. 2 HIA, is applicable. Although the reimbursement of fees is now referred to as a "sanction", the previous case law remains applicable, according to which no fault of the service provider is required.

The Federal Supreme Court dismissed Dr. med. A.'s complaint and confirmed…