26 July 2024 – In its decision of 24 June 2024, the Federal Supreme Court ruled on the appeal by A. AG regarding the reimbursement of urgent care inconvenience flat rates F (Dringlichkeits-Inkonvenienzpauschale 00.2505), emergency convenience flat rates A and B (Notfall-Inkonvenienzpauschalen 00.2510, 00.2520) and percentage surcharges for emergency B (Prozentzuschläge für Notfall 00.2530) under the TARMED tariff system. The main legal question was whether A. AG, which operates a walk-in clinic, was entitled to charge these rates even though its doctors were fixed-salaried employees.

The Arbitration Court for Health Insurance Disputes of the Canton of Bern partially upheld Helsana’s claim, ordering A. AG to repay CHF 393’295 for overcharged fees and dismissing the claim for interest on late payments.

The Federal Supreme Court confirmed the decision of the Cantonal Arbitration Court, concluding that A. AG could not charge urgent care inconvenience flat rates for doctors who were fixed-salaried employees. The Court held that the TARMED tariff system allowed such charges only for doctors who were not fixed-salaried employees of hospitals or similar institutions. The Court rejected A. AG’s argument that its walk-in clinic should be exempt from this rule, emphasizing that the distinction between fixed-salaried and non-fixed-salaried doctors was crucial to ensure that inconvenience premiums compensated only those doctors who were not otherwise remunerated for the inconvenience of emergency calls. In this regard, the organizational structure of the employer of the fixed-salaried doctors was not decisive.

The Court concluded by affirming the ruling of the Cantonal Arbitration Court and rejecting A. AG’s appeal.

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