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Aug 11, 2021

Georgiev, Todorov & Co. Law Offices successfully defended the rights of Uni Hospital on two instances against the National Health Insurance Fund for payment of over-the-limit medical activities

in Без категория

Uni Hospital General Medical Treatment Facility is one of the largest private investments in Bulgarian healthcare for the past 25 years. The hospital is located in Panagyurishte and offers precision by established specialists, unique medical care and state-of-the-art medical equipment.

Georgiev, Todorov & Co Law Offices filed claims on behalf of Uni Hospital General Medical Treatment Facility (Uni Hospital) against the National Health Insurance Fund (NHIF) for payment for hospital care services provided on clinical paths to health-insured persons above the limits set by the NHIF for the period 01.02.2017-30.09.2018 for an overall amount of over BGN 2 million including statutory interest.

The case was decided in favour of our client on first instance on 04.08.2020 when Sofia City Court fully upheld the claim filed by the healthcare establishment.

With a decision from 30.07.2021 the Appellate Court – Sofia confirmed the first instance decision with a reasoning which focuses on the fact 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 the citizens from the State to the providers of hospital care as they do not have the right to carry out commercial activity other than activities within the field of hospital care services, as well as to demand payment from the insured persons for activities within the scope of Article 45 of the Bulgarian Health Insurance Act.

Therefore, the court ordered the NHIF to pay the healthcare establishment the due remuneration for hospital medical care provided on clinical paths, medical and ambulatory procedures over the monetary limit set for the period above, along with the statutory interest until the final payment of the amount. The hospital will be able to claim all other expenses related to the claim.

Consequently, the healthcare establishment will be able to receive a fair amount, given the ongoing litigation in the past two years, instead of the proposed Terms and Conditions for payment of hospital care services, provided over-the-limits set by the NHIF for the period 2017 – 2018 (for more information see https://news.lex.bg/правото-или-плащанете-трудният-избор/). The Conditions provide for payment 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 Obligations and Contracts Act, by which hospitals must state a waiver from the payment of statutory interest, brought in court proceedings from the date of delay to the date of filing the claim, as well as the statutory interest due from the date of filing the claim with the court until the final payment of the principal. They must also waive expenses for state fees and remuneration for legal services.

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