In its decisions 9C_600/2023 and 9C_601/2023 of 1 October 2025, the Federal Supreme Court partially approved the appeal of several health insurers acting through the association Santésuisse and dismissed the appeal of the affected psychiatrist against the decision for restitution of the Health Insurance Arbitration Tribunal of the Canton of Neuchâtel.

The Arbitration Tribunal partially upheld the claim brought by Santésuisse for reimbursement for inappropriate services and ordered the psychiatrist to pay CHF 107’419.05. Santésuisse lodged an appeal against this decision, requesting that the psychiatrist be required to pay CHF 205’090. The psychiatrist also filed an appeal, arguing that she is not obliged to make any repayment.

The court ruled that the Arbitration Tribunal had chosen an admissible statistical method to examine the average costs per patient. The psychiatrist’s counterarguments were all rejected by the court, which found that she had failed to justify her increased costs.

On the other hand, the health insurers argued that the Arbitration Tribunal had set an excessive amount, which was covered by an alleged cost-coverage guarantee. The court noted that, once a cost-coverage decision has been issued, insurers cannot challenge the effectiveness of a treatment. However, the court held that the Arbitration Tribunal had assumed too high a proportion of treatments to be covered by a guarantee. Therefore, the court concluded that the Arbitration Tribunal’s calculation did not fully comply with the relevant requirements. It ordered the psychiatrist to reimburse CHF 173’422.58.

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