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Jul 20, 2020

Georgiev, Todorov & Co. Law Offices successfully defended the rights of a medical institution against the National Health Insurance Fund in a case for medical services provided above the limits set by the NHIF

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

On 15.07.2020 the Appellate Court – Sofia issued a decision annulling the first instance decision and ordered the NHIF to pay MHAT Tokuda the due remuneration for hospital medical care provided on clinical paths, medical and ambulatory procedures over the monetary limit set for April, November and December 2016, as well as for the period March-December 2017, along with the statutory interest until the final payment of the amount. The court’s decisive reasoning centers on the Constitution of the Republic of Bulgaria and the Health Act, according to which the formation and implementation of a health policy is an obligation of the state, and the inviolable right of every Bulgarian citizen to affordable medical care in compliance with the principles of timeliness, sufficiency and quality of the medical care.

According to Appellate Court – Sofia, it is inadmissible, through the use of the sovereign position of a state body – NHIF, and as a result of lack of proper planning of the expected costs, to limit the rights of citizens guaranteed by law for access to timely and quality medical care in a medical institution chosen by them. The hospital owes provision of medical care to all health-insured persons, who have requested it regardless of whether the set limits have been reached or not. Any different interpretation and application of the law would lead to unclear and in any case negative consequences for the health of patients, as the timeliness of medical care is a clearly defined guarantee of good healthcare in all relevant regulations.

The successful representation of the hospital in court was provided by Professor Ivan Todorov and our lawyers Maria Derelieva and Margarita Ivanova.