In its decision of 18 October 2024, the Federal Supreme Court dismissed the appeal of an operator of several elderly and nursing homes in the Canton of Vaud, upholding the decision of the Department of Health and Social Welfare (Département de la santé et de l'action social, DSAS) of the Canton of Vaud, which had denied reimbursement of CHF 728,836.21 for care costs (Restfinanzierung für Pflegekosten) incurred between 2013 and 2019. The court confirmed that the Canton of Vaud's financing system complied with the requirements set forth under the Health Insurance Act (Krankenversicherungsgesetz, KVG).

The dispute centred on the appellant’s request for reimbursement of care costs for residents requiring more than 220 minutes of care per day, particularly for those requiring more than 240 minutes of care per day. The appellant argued that the reimbursement provided by the Canton was insufficient and did not cover the full care costs, claiming this was in violation of federal regulations.

The Federal Supreme Court first examined whether the Canton of Vaud had fulfilled its obligations under the KVG to cover the remaining care costs, after contributions from mandatory health insurance and the insured individuals. The court determined that the funding provided by the Canton was adequate and in compliance with the law. The appellant failed to demonstrate that the funding was insufficient or violated federal law. The court also noted that the appellant had not considered additional sources of funding, such as hardship regulations and disability allowances, which are part of the overall funding structure.

On the substance of the case, the court addressed the appellant’s claim that the reimbursement system was discriminatory, particularly in relation to care exceeding 220 minutes per day. However, the court made it clear that, under federal law, the provider of care services has no right to be reimbursed for actual costs without regard to economic efficiency. The court highlighted that the financing system, including state contributions, was designed to ensure cost-effectiveness while still addressing legitimate care expenses.

Furthermore, the court pointed out that the appellant had failed to provide the necessary documentation, such as detailed financial records, as required by the relevant regulations. This lack of documentation prevented a comprehensive review of the claimed funding deficits.

In conclusion, the court upheld the reimbursement system used by the Canton of Vaud, finding it to be fully compliant with both federal and cantonal laws. The appellant’s claims were unsubstantiated, and the court dismissed the appeal.

For more information, see here.