Georgiev, Todorov & Co. Law Offices brought claims on behalf of Multi-profile Hospital for Active Treatment (MHAT) Doverie against the National Health Insurance Fund („NHIF”) concerning payment for medical care…
Georgiev, Todorov & Co. Law Offices brought claims on behalf of Multi-profile Hospital for Active Treatment (MHAT) Doverie against the National Health Insurance Fund („NHIF”) concerning payment for medical care provided by the hospital to health-insured persons above the limits set by the NHIF.
By way of Decision № 2000/08.11.2019, the Sofia City Court ordered the NHIF to pay MHAT Doverie the due remuneration for medical care provided on clinical paths over the monetary limit set in the agreement by the NHIF for 2017, along with the statutory interest until the final payment of the amount. The court’s decisive reasoning centers on the constitutional provisions (Article 4, Paragraph 2 and Article 52, Paragraphs 3 and 5 of the Constitution), according to which the formation and implementation of the health policy is an obligation of the state.
According to the court, proper internal budget planning is an obligation of the defendant NHIF as a compulsory health insurance authority. A deviation from the planned uniform spending of the budget does not limit NHIF`s obligation to pay the providers of hospital care services for all actually performed and reported medical care to health-insured persons. The hospital owes provision of medical care to all health-insured persons, who have requested it. Therefore, the contract between the hospital and the NHIF cannot be interpreted that if the hospital performed medical activity above the set monthly limits, it should be at its own expense. The medical services provided above the limits set by the NHIF, which the hospital was obliged to carry out, are subject to payment. This interpretation of the contracts is in accordance with the provision of Art. 20 of the Bulgarian Obligations and Contracts Act, which provides that the individual contractual arrangements shall be interpreted in their interrelation and each one of them shall be interpreted in the meaning ensuing form the contract as a whole, taking into account the objective of the contract, usages and practices, and good faith.
The hospital is represented in court by our lawyer Mariya Derelieva. Georgiev, Todorov & Co. Law Offices represents multiple other clients from the healthcare sector in number of cases against the National Health Insurance Fund for payments of medical care provided above the limits set by the NHIF.