HIBAPRESS – Abdellatif Baraka
The Administrative Court of Appeal in Agadir has issued a ruling obliging a private health institution to pay the amount of 2,352,150 dirhams, equivalent to 23.5 million centimes, to the National Social Security Fund, following a dispute related to irregularities detected in the billing of compulsory health insurance services.
The appeal decision, issued under number 1581, came after an appeal submitted by the health institution against an initial ruling issued in April 2024, which relied on a judicial expertise that proved the existence of unjustified discrepancies between the actual cost of medical services and the legally defined reference tariff.
– Background of the Case
The details of the case go back to a technical and financial audit conducted by the National Social Security Fund to cover the period from 2015 to 2017, during which it revealed an inflation in the prices of some examinations and medical tests, and the use of materials and medicines at costs exceeding the approved rates, in addition to not respecting the reference tariff determined by the decision of the Minister of Health No. 3207-15 dated September 23, 2015.
Based on these results, the Fund demanded the recovery of amounts it described as "undue," which the Primary Court responded to before the Court of Appeal confirmed it.
– Court Justification
The court considered that the health institution did not provide sufficient evidence to prove its respect for the legal tariff during the period under review, noting that the expert report relied on official documents issued by it, which enhances its credibility, and also found that the medical justifications that the institution adhered to remained without technical or accounting support to support it.
– Reactions
For its part, the National Social Security Fund welcomed the decision, considering that it reflects the administrative judiciary's commitment to supporting transparency and rationalizing health insurance expenses, and sends a clear message to health service providers about the need to adhere to the rules governing billing.
This decision comes in a national context that coincides with the project of generalizing compulsory health coverage, and with the increasing discussion about mechanisms for controlling the cost of treatment and ensuring the sustainability of insurance systems, in light of the confirmation of observers on the pivotal role of the judiciary in protecting public money and correcting the practices of some actors in the health system.
