Healthcare Law

THEVOZ & Partners assists its clients in the context of disputes between healthcare providers and insurers relating to compliance with the principle of cost-effectiveness (polypragmasie). We also have specialized skills in the drafting and review of cooperation agreements between health care providers and health care institutions, as well as in disputes arising from their implementation.

In particular, we advise our clients on all aspects of contractual relationships between healthcare providers and healthcare institutions (hospitals, private clinics, etc). In addition to employment relationships, which may raise specific issues in this area, the healthcare environment is characterized by the frequent use of partnerships or collaboration agreements between independent physicians and healthcare institutions. Several important elements must be addressed in order to clarify the rights and obligations of each party and to avoid disputes later on. This concerns in particular financial issues (definition of the extent of retrocessions due by the physician for the use of the infrastructures) and administrative issues (billing system, right to access the records, management of the secretariat, allocation of availabilities according to the capacities of the institution, etc.), as well as aspects related to patient records. The rules applicable in the event of termination of the partnership must also be precisely defined and ensure a fair balance between the interests of the parties. THEVOZ & Partners advises its clients in the drafting and negotiation of the contractual documents, so that the important elements are taken into account and addressed appropriately.

In the event of a dispute, our knowledge of the issues and specific aspects of this environment allows us to assist our clients in settlement discussions in order to promote an amicable and economical resolution of the dispute. If this is not possible, our expertise in procedural matters ensures that our clients receive an effective and tailored defense.

We also have extensive experience in defending physicians and other healthcare providers in restitution proceedings brought by insurers or their professional associations. Doctors and caregivers who charge services to the Swiss compulsory health insurance scheme (AOS) are subject to an economical audit of their practice. This control, carried out under the direction of santésuisse or tarifsuisse, consists of a comparison of the costs invoiced to the AOS by the doctor concerned with the average costs invoiced by other doctors in the same discipline. The results of this comparison are weighted by means of algorithms integrating different factors supposed to take into account the degree of morbidity of the patients of the compared doctors. If the index of the physician being compared is too high (usually 20 or 30 percent above average), the insurers can claim back the benefits corresponding to the excess. However, it is often the case that a difference in the costs invoiced to the AOS is not the result of uneconomical practice, but can be explained by the specific characteristics of the audited doctor, which differentiate them from the other doctors with whom they are compared.

It is essential for the doctor targeted by santésuisse or tarifsuisse to take immediate steps to identify the reasons why their index is higher than the average of the doctors with whom they are compared, in order to be able to explain the specificities of their practice in a precise and substantiated manner. When, despite the explanations provided, legal proceedings cannot be avoided, our expertise in this field and our extensive knowledge of procedural matters enable us to effectively defend our clients before the competent authorities (arbitration courts set up in each canton; Federal Supreme Court).