25 June 2026

In its judgment, the Federal Supreme Court (the Court) largely dismissed the appeal of a physician, a specialist in diabetology/endocrinology and in internal and general medicine, against a judgment of the Arbitration Tribunal for Insurance Matters of the Republic and Canton of Geneva (Tribunal arbitral des assurances de la République et canton de Genève, the Tribunal), which had ordered her to repay CHF 119’816.95 for the statistical year 2017 and CHF 161’069.10 for the statistical year 2018 to two groups of health insurers, represented by santésuisse, for non-economical treatment practices (polypragmasie) under Article 56 of the Health Insurance Act (Bundesgesetz über die Krankenversicherung, KVG). The screening method had produced regression indices of 189 (2017) and 201 points (2018) for her practice, against the reference value of 100 for the comparison group of diabetologists/endocrinologists.

The Court rejected the argument that the proceedings should have been suspended to allow the insurers to conduct an individual case review: under current case law, the economic efficiency review proceeds in two stages, a statistical screening followed by an individual assessment of the anomalies identified. Once a statistical anomaly is established, the insurers in principle continue to bear the burden of proof, but the service provider must substantiate any particularities of their practice. The physician had refused all cooperation, including with the court-ordered analytical expert assessment that she had herself, through counsel, previously described as indispensable, and had declined to provide the expert with the information on diagnoses and treatments required to examine her patients' files; she could therefore not rely on the resulting gaps in the expert report. Her objections to the composition of the comparison group also failed, the Tribunal having duly examined the alleged particularities of her practice; moreover, a comparison with general internists would, according to the expert, have been even less favourable to her.

The appeal succeeded on one point only: the procedural fine of CHF 2’500 imposed on the physician for her conduct in the proceedings was annulled, as Article 88 of the Geneva Administrative Procedure Act permits a fine for vexatious or abusive litigation only against the party initiating the proceedings, not against the defendant to an action.

For more information, see here.