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EstoniaRiigikohus

Supreme Court: Health Fund may reclaim provider fees by act

Tervisekassa may reclaim 8,386.60 euros from a physiotherapy provider by administrative act; the provider's June 2025 board petition counts as a challenge, making its court action timely.

By Taxxa AI OyPublished 10 November 2026

Legal & Corporate

Industry: Human health activities

The Administrative Chamber of the Supreme Court has confirmed that the Health Insurance Fund (Tervisekassa) may reclaim treatment fees paid without basis by issuing an administrative act and withholding the sum from the provider's future payoutsRiigikohus. No declaration of set-off under the Law of Obligations Act and no prior court judgment are required while there are future disbursements to withhold fromRiigikohus. A provider that disagrees must challenge the recovery demand as an administrative act in the administrative courtRiigikohus.

The dispute arose from treatment-financing contract no. 2024-RRL1-61033 between physiotherapy provider OÜ BioDesign and Tervisekassa. Reviewing July to December 2024, the Fund found documentation breaches and missing records, announced a demand of 8,386.60 euros on 18 March 2025, and issued a recovery demand on 5 June 2025Riigikohus covering twenty invoices whose records did not prove day-by-day activities or compliance with the list of health services. The demand cited § 4(1) of the Tervisekassa Act and the contract's annex 1, required payment within 30 days failing which the sum would be withheld from later payouts, and carried a 30-day challenge notice. The provider objected repeatedly from March to May 2025, petitioned the Fund's supervisory board on 26 June 2025Riigikohus, and sued in October 2025 seeking contract performance, annulment of the demand and payment of 8,386.60 euros with interest.

The administrative court treated the annulment action as out of time and returned the repayment claim; the circuit court reversed that, holding the demand was not an administrative act at all and the Fund had to declare set-off under private law and sue through the courts like any contracting party.

The Supreme Court, ruling on 10 November 2026Riigikohus in case 3-25-3486Riigikohus, dismissed the Fund's appealRiigikohus, left the circuit court's operative part standing but rewrote its reasoning. The treatment-financing contract is an administrative contract governed by public lawRiigikohus, and unilateral administrative acts are not excluded in such a settingRiigikohus: a public authority generally need not go to court to enforce its claimsRiigikohus. The power to withhold sums paid incorrectly or without basis comes from § 4(1) of the Tervisekassa ActRiigikohus, a public-law special rule that leaves no room for the Law of Obligations Act set-off provisions hereRiigikohus. The 5 June 2025 demand, given to regulate an individual case and imposing a binding payment duty, is an administrative actRiigikohus. Only where there are no future payouts to withhold from must the Fund obtain an enforcement document from the administrative courtRiigikohus. Electronic administrative acts must be titled so the binding direction is recognisable.

On procedure, the provider's letter of 26 June 2025, read with the earlier objections it referred to, had to be treated as a challenge (vaie)Riigikohus: informal form applies, and a defective submission obliges the authority to flag the defect and set a cure deadline. Because the Fund stayed silentRiigikohus, its handling counts as delayRiigikohus, so the delay-based time limit appliesRiigikohus and the annulment action with the withheld sum and interest is timelyRiigikohus. Quashing the demand directly restores the duty to make the withheld payouts, so no separate performance-claim limit needs assessing. The administrative court must now decide afresh on admitting the annulment actionRiigikohus.

Providers should treat a recovery demand as a challengeable actRiigikohus, object within the stated deadlineRiigikohus, and sue within the delay-based limit if the Fund does not decide the challengeRiigikohus.

Legal basis: order of the Supreme Court Administrative Chamber of 10 November 2026 in case 3-25-3486, applying the Tervisekassa Act § 4(1), Ravikindlustuse seadus § 35(2) and § 37, Haldusmenetluse seadus §§ 36, 51(1), 55(1), 76, 78 and 105(1) and Halduskohtumenetluse seadustik §§ 37(2)(2), 46, 47(3), 109(2), 121(2)(2), 260(1)(1) and 262(2).

Treat a Tervisekassa recovery demand as a challengeable administrative act: file reasoned objections within the deadline stated in the demand and, if the Fund does not decide the challenge, bring the annulment action within the delay-based time limit.

Sources

3-25-3486/18 - Kohtumäärus