March 27, 2025
In accordance with the contractual stipulations, the practitioner benefited from :
The contract also stipulated that the establishment was responsible for billing and collecting the practitioner's fees from health insurance organizations.
In return, the practitioner was required to pay a flat-rate monthly fee set at 8% (incl. VAT) of the conventional fees earned.
From January 1, 2013, the practitioner had stopped paying the fee, citing malfunctions and misappropriation of funds within the establishment. The establishment sent him two formal notices in 2019, then initiated legal proceedings in 2021.
The Versailles judicial court ordered the doctor to pay 36,070.98 euros in unpaid fees with interest to the establishment.
Contesting the validity of the royalty clause, the amount claimed and requesting compensation, the doctor appealed on June 15, 2022, arguing in particular that the private practice contract infringed the fundamental principles governing private practice by establishing an unbalanced and unjustified fee system between the establishment's practitioners.
Rejecting these claims, the Court of Appeal ordered the appellant to pay 43,850.50 euros to the healthcare establishment, with interest, and rejected the claims for annulment of the contract clauses.
- Loyal performance of contracts: the Court recalls thata practitioner cannot unilaterally cease payments without justifying a serious breach by the establishment.
- Restrictions on benefits : the Court emphasized that restrictions on benefits are a matter of public policy. It is therefore not possible to derogate from the provisions of article L. 1453-3 of the CSP, which prohibits practitioners from receiving any benefit from healthcare establishments, whether public or private. The Court therefore confirms the validity of the fee and the legitimacy of collecting fees in return for services provided by the establishment. Such payments are considered legitimate as long as they correspond to a genuine service and not a disguised advantage.
-Prohibition of compérage: the Court insists on the prohibition of compérage set out in article R. 4127-23 of the CSP, i.e. the prohibition of collusion between two or more persons with a view to obtaining advantages to the detriment of the patient or third parties. As medical fees are personal, they cannot be shared, which justifies their difference. The Versailles court ruled out the existence of compérage and validated the fee clause, basing its decision on case law which accepts that such agreements are lawful provided the services concerned are genuine and proportionate.
The Court relied on the positions taken by the Cour de cassation on this subject:
The French Supreme Court (Cour de cassation) has already recognized that healthcare establishments may charge doctors a fee proportional to their fees(Ass. plén., May 28 1976, no. 75-10.371, Lechat c/ Société clinique du Léman). This fee may be a percentage of the practitioner's fees, provided it corresponds exclusively to a service rendered and to expenses incurred by the clinic(Cass. civ.1, June 27, 2000, no. 98-19.565).
If the fee is deemed too high, the judge does not set it himself, but invites the clinic and the doctor to renegotiate on the basis of an expert's assessment(Cass. civ. 1, May 20, 2003, no. 02-15.249 and no. 02-15.250).
With regard to the burden of proof: the Court recalls that it is up to the doctor to demonstrate that the fee does not correspond to the services actually provided. In this case, the appellant asserted that certain practitioners were subject to a fee of 5% exclusive of tax, while others, including himself, paid a fee of 8% inclusive of tax. However, as he did not prove that the services rendered were identical for all these practitioners, the comparison was not permitted.
