Long-standing dispute over payment for the so-called “overperformance” ended with a settlement

Long-standing dispute over payment for the so-called “overperformance” ended with a settlement

On 18 February 2022, a dispute between one of the hospitals in the Wielkopolska region and the National Health Fund over payment for the so-called “overperformance”, i.e. services provided by the healthcare entity that were not financed under the contract concluded with the public payer, that had lasted since 2013, ended.

The crux of the dispute was the question of the existence of the National Health Fund’s obligation to pay for health services provided to patients under conditions of statutory coercion (i.e. in a state of threat to health or life). In the pending proceedings, the hospital indicated that it was under an absolute obligation to treat patients, regardless of the financial limit granted in the concluded contract. In all cases covered by the claim, the patients required medical treatment that could not be postponed.

The hospital, despite applications submitted to a branch of the National Health Fund, did not receive remuneration for the provision of services. As a result, it first summoned the payer to conclude a settlement agreement, and then – brought an action for payment. As a result of discussions, the parties eventually managed to reach a consensual position.

By virtue of the court settlement, the National Health Fund agreed to pay the Law Firm’s Client a sum of PLN 482,643.11.

The case was conducted by attorney-at-law Magdalena Cieślińska-Dopierała and barrister Paulina Kozłowska from the Department of Medical Law and Services to Medical Entities.

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