Diederik Schrijvershof, Annabel Kingma and Leah Peeters successfully litigated in summary proceedings on behalf of 23 providers of orthopedic footwear against a current multi-year agreement of CZ. The interim relief judge vindicated the orthopedic footwear providers and CZ must implement a substantial rate increase in December 24 and for 2025.
Background and ruling
The contract drawn up unilaterally by CZ was to be entered into by the healthcare providers in 2020 for the years 2021 and 2022. Following this, the CZ contract was tacitly renewed for the years 2023, 2024 and 2025. CZ did not index the rates up to and including 2023 and hardly did so thereafter.
The preliminary relief judge concluded that the 23 providers of orthopedic devices are dependent on CZ, as it is virtually impossible for them to work without a contract. Referrers and partners of orthopedic footwear providers (such as general practitioners, hospitals and rehabilitation centers) require orthopedic footwear providers to have a contract with all insurers, including CZ. If orthopedic footwear providers do not have one or more of those contracts, they will no longer refer all their patients to them.
With such a dependency, a health insurer, such as CZ in this case, must adequately consider the legitimate interests of health care providers. The Court of Appeal also considered this before, in the STAR judgment. Based on that STAR judgment, the interim relief judge concluded that CZ may not categorically refuse to index its rates.
According to the preliminary relief judge, the NZa index figures and the OVA (government contribution to labor development) are useful and objective tools to approach cost price increases in the field of personnel and material costs. Based on those figures, the court in preliminary relief proceedings in this case ruled that CZ must, in the current multi-year contract:
- for December 2024 increase the rates by 16%; and
- for the year 2025 increase the rates by 20%.
This adjusts the current CZ contract. The ruling can be read here. The ruling is provisionally enforceable. This means that even if CZ were to appeal, CZ would have to adjust the rates upward in 2024 and 2025 for the healthcare providers. The STAR ruling shows that appealing is risky for a health insurer.
Cost-covering rates and indexation in healthcare
Maverick Advocaten achieved success with the STAR ruling (the basis for this ruling) in July 2024. With the STAR ruling in hand, Maverick Advocaten also achieved success earlier this year in proceedings against another major health insurer for 23 providers of orthopedic devices, see here.
Maverick Advocaten also achieved success in summary proceedings on behalf of seven mental health providers against CZ Zorgkantoor (see also here). CZ Zorgkantoor was planning an abrupt transition from modular to integral financing. This transition would increase the administrative burden for care providers. In this case the interim relief judge of the District Court of The Hague ruled that the working method of the healthcare office was in conflict with the IZA. The IZA aims to reduce the administrative burden.
Maverick Advocaten assists healthcare providers on a daily basis to achieve cost-covering healthcare rates or to challenge inadequate turnover and other caps. It is litigating, for instance, on behalf of providers of forensic mental healthcare against the NZa’s 2023 Mental Healthcare and Forensic Care Rates Decision. Maverick Advocaten is also litigating on behalf of De Bevlogen Huisartsen, a foundation, and 129 individual GPs against the NZa’s 2023 GP Care Rates Decision. Previously, Maverick Advocaten achieved successes in preliminary relief proceedings for healthcare providers in the procurement of, among other things, GP care, acute mental healthcare (here and here), forensic care, youth care, SGLVG (Serious Behavioural Problems and Mild Intellectual Disability) care, long-term care (also on appeal) and care under the Social Support Act (see also here). Maverick Advocaten also challenges excessive market power of health insurers: see also here.
More information on the healthcare procurement duty/duty of care and its enforcement is provided in this blog, this blog and this interview in Zorgvisie. More information on the rights of healthcare providers in healthcare sales and the possibilities for their industry associations to support them in this regard can be found at www.zorgcontractering.com
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