TF, 27.02.2026, 9C_274/2024
Facts
A limited company (hereinafter: the appellant) operates outpatient medical centers within the framework of "Managed Care" (HMO) insurance models. Under collaboration agreements with health insurance funds, it provides care coordination and management services for policyholders of these models in exchange for a flat-rate fee (consisting of a fixed amount per insured person and a variable portion linked to efficiency).
After benefiting from a VAT exemption based on a 2010 ruling, the appellant was notified by the Federal Tax Administration (FTA) that these services would be subject to VAT as of January 1, 2017. The FTA issued tax assessments for the 2017 to 2019 periods, considering that the services provided to the health insurance funds were not exempt medical treatments. The Federal Administrative Court upheld this decision, prompting the appellant to appeal to the Federal Supreme Court.
Law
The dispute concerns the interpretation ofArt. 21 para. 2 item 3 of the VAT Act (VAT Act) in its version applicable to the 2017-2019 periods. This provision exempts medical treatments in the field of human medicine from VAT. According to Art. 34 para. 1 of the VAT Ordinance (VAT Ordinance), medical treatments include the diagnosis, treatment, and prevention of diseases.
The Federal Supreme Court notes that a new provision, Art. 21 para. 2 item 3bis of the VAT Act, entered into force on January 1, 2025. This specifically exempts "coordinated care services in connection with medical treatments." The Court specifies that exceptions to tax liability must be interpreted restrictively.
For a service to be taxable, there must be an exchange relationship, meaning a direct link and economic equivalence between the service provided and the consideration received.
Application to the specific case
The Federal Supreme Court examines whether the "Managed Care" services provided by the appellant to the health insurance funds can be classified as "medical treatments" within the meaning of Art. 21 para. 2 item 3 of the VAT Act.
It first analyzes the scope of the new law (Art. 21 para. 2 item 3bis of the VAT Act). The fact that the legislature deemed it necessary to create a new specific exception for coordinated care demonstrates, according to the Court, that these services were not covered by the concept of "medical treatment" under the former provision. An extensive interpretation of the former law that would anticipate the effects of the new law is not permissible.
Next, the Court distinguishes between the appellant's services:
- Direct medical treatments provided to patients, which are clearly exempt.
- "Managed Care" services provided to health insurance funds under the collaboration agreements.
Regarding the latter, even if certain coordination activities are closely linked to patient treatment, the Court finds that the exemption fails due to the absence of a sufficient exchange relationship. The remuneration paid by the health insurance funds is a flat-rate, global compensation. It remunerates the appellant's general commitment to provide a coordinated care system for a group of insured persons, rather than specific and identifiable services in concrete treatment cases. There is therefore no direct link or equivalence between an individual coordination service and the remuneration received.
Consequently, the "Managed Care" services billed to insurers cannot be classified as exempt medical treatments under the law applicable for the years 2017 to 2019.
Issue
The Federal Supreme Court has dismissed the appeal. It confirms that the "Managed Care" services provided by the appellant to health insurance funds during the 2017 to 2019 tax periods are not exempt from VAT under Art. 21 para. 2 item 3 of the Swiss VAT Act. Legal costs are to be borne by the appellant.
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