Is the FOPH not fulfilling its supervisory role?
Hospitals are not allowed to bill the day of discharge as a hospital day. On the instructions of the Federal Office of Public Health (FOPH), health insurance companies bill this day anyway - at the expense of the patient. This is already the second case within a short period of time in which a court has confirmed that the FOPH has not correctly interpreted the legal basis to the detriment of the insured. Consumer Protection therefore wants clarification as to whether the FOPH's supervisory duty is also failing in other areas to the detriment of the insured. It is therefore making representations to the Swiss Federal Audit Office (SFAO), which is to review the FOPH's supervisory activities. In addition, he is calling for a lump-sum refund of wrongly charged costs.
© Depositphotos/AlexLipa
The rule of the hospital tariff is clear: the day of discharge after inpatient treatment may not be billed as a hospital day. Nevertheless, the BAG the health insurance companies to also cover the last day of a Hospitalization to charge, burdening patients with millions of dollars in additional annual costs. In a ruling on May 23, 2019, the Social Insurance Court of Zurich confirmed the obvious: This procedure is inadmissible.
As justification for its recommendation, the BAG that there was no federal court ruling on this question. This reasoning is absurd, because the FOPH itself would have had the opportunity to appeal the currently valid ruling and thus bring about a federal court decision. Nevertheless, it refrained from doing so. Thus, the present ruling from Zurich is legally binding.
Hospital costs charged incorrectly for years
A few weeks ago, a similar case became public: All major Health insurance companies have been charging hospital costs incorrectly for years on the recommendation of the FOPH - also at the expense of patients. The Federal Court ruled that this was also inadmissible.
For Consumer Protection, these two cases show that the FOPH is failing in its supervisory role. Sara Stalder, Executive Director of Consumer Protection, comments: "Once again, it is evident that the FOPH has interpreted the legal basis in an inadmissible manner to the detriment of the insured. This raises the question of whether these two cases are just the tip of the iceberg. We therefore recommend that the Swiss Federal Audit Office review the FOPH's supervisory activities." In addition, the consumer protection demands that the wrongfully collected amounts be refunded. Dis would be easy to handle with a flat-rate contribution - so that no huge administrative process has to be created for this. "Based on the FOPH's directive, insured persons were charged unjustified amounts for years. These must be refunded."
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