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Feb 26, 2019

Georgiev, Todorov & Co. Law Offices successfully defended on first court instance the rights of a hospital in a case against NHIF for medical services provided above the limits set by the NHIF

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Georgiev, Todorov & Co. Law Offices  brought claims on behalf of Acibadem City Clinic Tokuda Hospital against the Bulgarian National Health Insurance Fund (the “NHIF”) concerning payment for medical care provided by the hospital to health-insured persons above the limits set by the NHIF for the hospital.

By way of the first court instance decision № 2226/07.11.2018, the Sofia City Court ordered NHIF to pay the hospital the due remuneration for medical care over the limit set in the agreement by the NHIF for the period of May-June 2015 along with the statutory interest until the final payment of the amount. The court’s decisive reasoning centers on the right of health-insured persons to freely choose the hospital they wish to be treated in and accordingly the hospital’s duty to admit them for treatment.

According to the court, given that the law exempts insured persons from the obligation to pay for the health care included in the medical package guaranteed by the NHIF, and obliges healthcare providers to admit for treatment the persons who have requested it, then the provision of hospital care cannot be based on the discretion of the healthcare provider whether to provide it as well on financial constraints. This is an expression of the commitment of the state to provide effective health care, which is constitutionally guaranteed. Given that the purpose of the hospital care contracts is to finance the provision of medical care rather than the use of the amount set by the NHIF, the basis for the obligation to pay is precisely the health service provided.

The decision is not final and is subject to appeal before the Sofia Court of Appeal.

The law firm’s team preparing the legal defense of Tokuda Hospital includes Prof. Ivan Todorov, Ph. D, managing partner, Maria Derelieva, senior associate and Monika Markova, associate.

Georgiev, Todorov & Co. Law Offices represents its clients in the healthcare field in a number of cases initiated against the National Health Insurance Fund for payment of medical care provided above the limit set by the NHIF.