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Georgiev, Todorov & Co Law Offices filed claims on behalf of „Acibadem City Clinic Tokuda“ EAD against the National Health Insurance Fund (NHIF) for payment of hospital care services, provided on clinical paths to health insured persons above the limits set by the NHIF.
The case was won at first instance, and the Court fully upheld the claim, filed by the healthcare establishments. The Court of Appeal confirmed the first-instance decision, with decisive motives, that the delegated budgets, introduced by the law, as a basic principle for financing the activity in the field of hospital care, do not aim and cannot transfer the financial burden of protecting the health of citizens from the State to the providers of hospital care as they do not have the right to implement commercial activity other than activities within the field of medical care services, as well as to demand payments from the health-insured persons for activities within the scope of Art. 45 of the Health Insurance Act.
By Ruling № 233 of 1st of December 2020, the Supreme Court of Cassation of the Republic of Bulgaria does not allow cassation appeal against the Court of Appeal`s decision, due to which the latter entered into force.
Therefore, the medical institution will be reimbursed for 2015 with the due remuneration for the hospital care provided, above the limit set by the NHIF, as well as the legal interest claimed in the court proceedings from the date of delay to the date of filing of the claim and the legal interest due by the date of filing the claim before the court until the final payment of the principal amounts. The hospital will be able to claim all the incurred office expenses.
Consequently, the healthcare establishment shall be able to receive a fair amount, considering the long-running lawsuit, instead of the proposed under the Terms and Conditions for payments of hospital care services provided over-the-limits set by the NHIF for the period 2015-2016 (for more information see https://news.lex.bg/правото-или-плащането-трудният-избор/ ). The Conditions provide for payments of hospital care services, after the conclusion of an agreement between the healthcare establishments and the NHIF, within the meaning of Art. 365 of the Contracts and Obligations Act, by which hospitals must state a waiver from the payment of statutory interest, brought in court proceedings from the date of the delay to the date of filing the claim, as well as the legal interests, due from the date of filing the claim until the final payment of the principal. They must also waive expenses for state fees and remuneration for legal services.