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Position: Medical or dental care provided in a doctor’s premises

Medical companies can enter into agreements with companies that run a so-called medical center. The agreements mean that the medical companies must conduct operations in the medical center’s premises . The equipment needed for the operation is normally provided by the doctor’s office. The medical companies can also have access to certain medical services performed by staff employed by the medical center. This may include, for example, counseling of nurses, sampling, medical examinations and assistance with examinations and operations. The doctor’s office normally also provides a common reception, computer records, telephone, website etc.

An agreement to conduct business within the framework of a medical center can have different meanings. The agreement may mean that it is the medical center that will provide services for compensation to the medical companies, for example by providing access to premises, equipment and other services. In such a case, Läkarhuset makes it possible for the medical companies to jointly use different resources needed to provide healthcare.

In other cases, the agreement may mean that it is instead the medical companies that must provide services for remuneration to the medical center, e.g. by making medical staff available for a care clinic run by the medical center.

Who provides care to the patient?

In a first step, it is necessary to assess whether it is the medical center that provides services for remuneration to the medical company or whether it is instead the medical company that provides services for remuneration to the medical center (cf. HFD 2021 ref. 29 ). An assessment must primarily be made on the basis of the agreement between the medical center and the medical company.

If it is stated in the agreement that the medical company shall provide services for remuneration by making medical staff available to the medical center, it may be the question of staffing that is covered by tax liability. In such a case, it is the medical center that may be considered to run the care clinic and thus provides health care services directly to the patients.

If, instead, it is the medical center that according to the agreement provides services for remuneration to the medical company, an assessment must be made of what these services consist of and whether it is a question of a single provision or several different provisions. Services that can be provided by a medical center are, for example, the provision of staff, premises and equipment. In such a case, it is the respective medical company that may be considered to run the care clinic and which thus provides healthcare services directly to the patients. The medical company thus does not provide staff to the medical center.

However, there is nothing to prevent the medical center as such from running its own care clinic for certain other healthcare and having its own agreement with the region for the provision of that care. In such a case, it may happen that both the medical center and the medical company provide services for compensation to the other party. The medical center can, for example, provide premises, equipment, etc. to the medical company for its reception activities. At the same time, the medical company can provide services to the medical center for the reception activities that the medical center conducts, e.g. by making staff available. An assessment must always be made in the individual case of which services for remuneration that the medical center and the medical company provide to each other.

If there is no written agreement between the parties, if the agreement has an unclear meaning or if the business is conducted in a way that differs from the agreement, an assessment must be made based on other circumstances. An assessment must be made of whether it is the doctor’s office or the doctor’s company that runs the care clinic and thus provides the care to the patient. This means that the care must be provided from a separate organizational structure and not be included in the other contracting party’s organization.

The Swedish Tax Agency considers that the person who, on his own account and under his own responsibility, may be considered to provide care to the patients in such a case is the person who

  • has the overall responsibility for the tasks to be performed,
  • determines which patients should receive the care, and
  • determines during which times the care is to be provided.

The above conditions are further specified below and under the headings “Healthcare is provided by the medical center” and “Healthcare is provided by the medical companies”.

When medical care is provided within the framework of an agreement with a medical center, the medical center’s resources are used, regardless of whether it is the medical center or the medical company that may be considered to run the care clinic and provide care services to the patients. The fact that it is the medical center’s resources that are used is therefore not of decisive importance for the assessment of who provides the care to the patients when the care is provided “in a medical center”.

In the opinion of the Swedish Tax Agency, it is also not of decisive importance who has signed a collaboration agreement with the region and receives compensation from the region in accordance with section 5 of the Act (1993: 1651) on medical care compensation. These collaboration agreements with the region are always concluded with the individual doctor (the natural person). The agreements are personal and cannot be taken over by the medical center, even if it is the medical center that runs the care clinic and provides the care to the patients.

The fact that a medical company has a managerial role vis-à-vis its employees is irrelevant for the assessment of whether the company is included in the medical center’s organization. Decisive is the extent to which the medical company as such must act within the framework and follow the instructions determined by the medical center.

The fact that health care personnel decide how the care is to be performed does not mean that that staff, or their employer, has an overall responsibility for which tasks are to be performed. The fact that health and medical staff have a responsibility that follows from law for how they fulfill their duties and are under the supervision of the Swedish Health and Care Inspectorate (IVO) does not affect that assessment.

Below are examples of circumstances that indicate that the medical center and the medical company run the care clinic and provide the care to the patients. The examples further develop the circumstances stated in the indents above and which, according to the Swedish Tax Agency, are important for the assessment of who provides the care to the patients.

Medical care is provided by the medical center

The following examples of circumstances indicate that the medical center provides care to the patients and thus is the patients’ counterpart. The list is not exhaustive, but there may be other circumstances that are important. An overall assessment must always be made of all the circumstances that emerge in the individual case.

  • Läkarhuset books patients and decides which patients should get an appointment with the doctor, ie the doctor is obliged to receive the patient. The fact that the patient may have wishes for a treating physician is irrelevant.
  • Läkarhuset decides what times the medical companies must be available to perform their services. This is the case if it appears from the agreement with the medical center that the medical company is obliged to be available during certain specific times and that holidays or other leave must be approved by the medical center.
  • The doctor’s house determines the framework for the medical care to be provided, e.g. which treatments are to be performed.
  • The medical center must give consent if a medical company replaces a doctor with another doctor or has the right to request that a doctor be replaced.
  • On the receipt issued to the patient when paying the patient fee, the doctor’s office is stated as the seller of the care service.
  • It is the medical center that, according to the law on systems of choice, has an agreement with the region for the care that the medical company performs. However, the fact that the medical center has such an agreement with the region for the care that the medical center itself provides in its own reception operations does not affect the assessment.

If the medical center provides care to the patients, the medical companies’ services may be to make medical staff available to the medical center, ie staffing.

Healthcare is run by medical companies

The following examples of circumstances indicate that the medical companies provide care to the patients and thus are the patients’ counterpart. The list is not exhaustive, but there may be other circumstances that are important. An overall assessment must always be made of all the circumstances that emerge in the individual case.

  • The medical companies decide their own working hours and holidays. The fact that the medical companies may have an obligation to notify the medical center of the times they are available is irrelevant. Such information may be necessary for the medical center to be able to provide service to the medical companies, e.g. via the reception or through information on the doctor’s website.
  • The medical companies determine the focus of the business.
  • The medical companies themselves decide which and how many patients they want to receive.
  • The medical companies independently determine the framework for the care patients should receive and the extent to which other professional categories need to be used.
  • On the receipt issued to the patient when paying the patient fee, the medical company is stated as the seller of the care service.
  • It is the medical company that according to the law on systems of choice has an agreement with the region for the care that the medical company performs.

If it is the individual medical companies that provide care to the patients, the medical center’s provision to the medical companies can consist of various services such as local provision, access to equipment and staff.

Source: skatteverket.se

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