In its decision of 18 October 2024, the Federal Administrative Court upheld the appeal of A., a holder of a medical degree and a specialist diploma in ophthalmology, obtained in France and recognised in Switzerland by decisions of the Medical Professions Commission (Medizinalberufekommission, MEBEKO), who had challenged the decision of the Department of Security, Population, and Health (Département de la sécurité, de la population et de la santé, DSPS) of the Canton of Geneva. The department had rejected her application for authorization to bill the compulsory health insurance (Obligatorische Krankenpflegeversicherung, OKP) as an ophthalmologist in Geneva.

The case arose from the appellant's repeated attempts to obtain authorization to bill the OKP in the Canton of Geneva, despite being authorized to do so in the cantons of Vaud and Wallis. The department rejected her last application in 2022, which was linked to a proposed cooperation project in Geneva, based on a negative assessment from the Quadripartite Consultative Commission. The department argued that the ophthalmology sector in Geneva was sufficiently staffed and supported its position with various statistics.

The court addressed two primary issues: (1) the failure of the DSPS to consider the updated legal provisions that came into effect, including Article 55a of the Health Insurance Act (Krankenversicherungsgesetz, KVG), the Ordinance regulating the setting of maximum physician quotas in the outpatient sector, and the relevant cantonal implementing regulations, and (2) the insufficiency of the reasoning provided in the decision, which hindered the appellant’s ability to adequately contest the ruling. The court emphasized that the department had not considered the new legal framework governing the authorization of medical professionals to bill the OKP and had failed to provide adequate justification for its claim that the ophthalmology sector in Geneva was sufficiently covered.

As a result, the court annulled the decision and referred the case back to the DSPS for a new evaluation, taking into account the updated legal provisions.

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