18. September 2024 – In its decision of 23 August 2024, the Federal Supreme Court dismissed the appeal of an independent nursing specialist against the decision of the Cantonal Arbitration Court for Social Insurance Disputes (Tribunal arbitral des assurances sociales) of the Canton of Geneva. The Cantonal Arbitration Court had ordered the appellant to repay a total of CHF 260,106 to several health insurers for alleged excessive billing under the compulsory health insurance (obligatorische Krankenpflegeversicherung, OKP).

The Federal Supreme Court pointed out, that the appellant, as a service provider, was obligated to invoice only for economic, appropriate, and necessary services. For 2016, the appellant had invoiced 5,029.75 hours, which corresponded to a hypothetical working time of more than 13.45 hours per day, seven days per week. The Court found that such a figure exceeded the permissible working time regulations and constituted «polypragmasia» (excessive and unjustified billing practices; Überarztung). Additionally, the Court found that the billing errors included the improper aggregation of various services, which further substantiated the necessity of the repayment claims. Therefore, the complainant had applied an excessive charge for routine services and had accumulated tariff items in a manner that contravened the regulations, with the consequence that the services, although individually approved by the insurers, failed to meet the requirements of the insured's interests and the treatment objective.

The appellant contended that the repayment claims were barred by the statute of limitations. In line with established case law, the Court dismissed this argument. The limitation period for repayment claims only commenced after the relevant statistical data had been provided to the health insurers, and not at the time of the invoicing control. Furthermore, the appellant argued that his right to be heard was violated because the Cantonal Arbitration Court did not consider all the evidence he had requested. The Court concluded that the Cantonal Arbitration Court could adjudicate properly based on the evidence already on record and that no additional evidence was required.

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