Administrative Court – Silistra confirmed a sanction of the Health Insurance Fund against a doctor

The Administrative Court – Silistra confirmed an order of the Regional Health Insurance Fund (RDIF) – Silistra, partially terminating the contract of the “Primary Medical Care Clinic – individual practice – Dr. M.B.” Ltd.

The case study:

• RZOK – Silistra imposes a sanction on “Ambulatory for primary medical care – individual practice – Dr. M.B.” Ltd. for non-performed activity.
• The sanction is a partial termination of the contract for Dr. M.B.
• The decision of the ROC has been confirmed by a court.
• After entry into force of the sanction, the outpatient clinic concludes a new contract with the RZOK.
• RZOK partially terminates the new contract, referring to the sanction from the previous contract.
• “Primary medical care clinic – individual practice – Dr. M.B.” EOOD is appealing this decision.

Decision of the Administrative Court – Silistra:

The court affirms the decision of the RZOK on the grounds that:

• There are two contracts between the outpatient clinic and the RHOC – one under the NRD regime for MD for 2020 – 2022, and another – under the NRD regime for MD for 2023 – 2025.
• The first contract is sanctioned with partial termination for non-performed activity.
• The sanction entered into force after the conclusion of the second contract.
• Art. 103, para. 3 of the NRD for MD for 2023 – 2025 allows the termination of a contract with IMP without notice, if during its operation a sanction “termination of contract” has entered into force under Art. 59, para. 11, item 1 or 2 of the PPE, issued in accordance with the previous NRD.
• All prerequisites for termination of the second contract are present.

The decision is subject to appeal within 14 days of its notification to the Supreme Administrative Court.

Source: Administrative Court – Silistra