Huge blunder in invoicing emergency fees

This is something the Swiss health system could have done without. According to two decisions of the Federal Court taken this summer, many doctors have for years overcharged a tax of around 40 francs, when they worked outside conventional hours, in the evening, on weekends or on public holidays.

According to the newspaper “Le Temps”, which revealed the affair on Wednesday, a group of 25 health insurers challenged this approach all the way to the Federal Court, which ruled in their favor. Not only do doctors and other practices no longer have the right to charge the tax, but some are required to reimburse the amounts unduly collected over the last five years. Which can represent colossal sums.

The Geneva daily takes the case of the Vidymed group in the canton of Vaud, which intervenes in emergency around 100,000 times per year, a third of which in the evening, on weekends or on public holidays: “For the group, all insurance combined, the disputed emergency taxes amount to 2 million francs per year, explains Didier Mann, administrative and financial director of the group. That is 10 million over five years, out of an annual turnover from our emergencies of 17 million. This loss is enormous for us.

The director decided to resist: “We have decided to grit our teeth and leave our emergency centers open while continuing to bill the planned compensation. We billed these taxes for thirty years and, suddenly, this practice becomes illegal, while Vidymed’s emergencies serve as a shield against those of the CHUV.

According to the “Temps” survey, some firms risk bankruptcy, others are considering giving up emergencies or laying off staff. Children’s medicine is particularly affected. In Zurich, the Swiss Medi Kids group, which has 80,000 child consultations per year, calculated that these taxes represented 14% of its turnover.

In Geneva, pediatricians have announced a strike notice. They deplore “an attack on their dignity and respect for their work”. Michel Matter, president of the Association of Physicians of the Canton of Geneva, believes, however, that it is futile to fight “against the judgments of the Federal Court. But insurers’ requests for retrocession are unfair and cynical.

“We can think that certain large firms had made the collection of this emergency tax a business model, based on a somewhat questionable interpretation of Tarmed,” defended SantéSuisse spokesperson Christophe Kaempf on RTS. . For its director, Verena Nold: “This billing did not correspond to the rates approved by the Federal Council.”

Contacted by “Le Temps”, Helsana insurance also justifies the policy of insurers “with respect to people who pay their premiums, to reimburse only the services authorized by the law on health insurance. We strive to find an appropriate solution with all service providers.

However, these taxes have indeed been paid for years by patients and policyholders, who would be entitled to claim them. But given the scale of the task, the money will end up in the fund reserves… “The analyzes to directly redistribute these amounts would cost even more,” notes Verena Nold. By integrating these funds into the reserves, policyholders will still benefit, because this will moderate premium increases.”