Medical expert

from Wikipedia, the free encyclopedia

A medical expert (also: medical expert ) is a physician who is responsible for a client (e.g. courts , insurers , professional associations , lawyers , private individuals ) on questions of health, illnesses, incorrect treatment ( treatment errors ) and physical harm to patients and Test subjects take a position. Medical experts support the decisions of courts and authorities, as well as social and private insurance carriers about their obligation to pay through the medical assessment. Medical expertise may also be required to assess the correct application of medical or dental fee schedules. Such pricing issues, in a fee report position taken.

Legal issues

According to the Code of Civil Procedure (ZPO) and the Code of Criminal Procedure (StPO) as well as the professional code ( BO) of the respective regional medical association based on the model professional code ( MBO) of the Federal Medical Association , every licensed doctor in Germany is obliged to prepare an expert opinion in court. The same applies to the licensed dentist. According to Section 407a of the German Code of Civil Procedure, the expert must immediately check whether the order falls within his area of ​​expertise and whether it can be completed without the involvement of other experts. If this is not the case, the expert must inform the court immediately. Furthermore, he is not authorized to transfer the order to someone else. If he makes use of the cooperation of another person, he has to name this person and indicate the scope of their activity, if it is not an auxiliary service of minor importance. If the expert has doubts about the content and scope of the order, he must immediately bring about a clarification by the court. The same reasons that entitle a witness to refuse to testify entitle an expert to refuse to give an opinion . The court can also release an expert from the obligation to provide the expert opinion for other reasons ( Section 408 ZPO).

If an expert does not appear or refuses to provide an expert opinion, although he is obliged to do so, or if he retains files or other documents, he will be charged the costs incurred in accordance with Section 409 ZPO. At the same time, a fine can be set against him.

designation

There is basically no difference between the terms “medical expert” and “medical expert”. In the context of the judicial gathering of evidence, however, only the term "expert" is used. The reason is that the legal texts only use this designation.

Independent evidence procedure

An Independent of evidence can possibly be done if the evidence is threatened by loss of evidence § 485 para. 3 ZPO. In the event of a malpractice, this can sometimes be necessary in order to secure the findings (hence the earlier term evidence preservation procedure ) before the condition could be changed by further treatment measures and further treatment is urgent. If an assessment has already been carried out in the process of preserving evidence, according to Section 485 (3) ZPO, a new assessment as part of an independent evidence procedure is only possible if the requirements of Section 412 ZPO are met, namely if the expert was successfully rejected due to bias or if the expert opinion was inadequate is.

Qualified party presentation

Private appraisals are not admitted as evidence in court, but only as a qualified party presentation , because an appraiser unilaterally employed by a party does not guarantee independence like a court-appointed appraiser. The qualified party submission is to be observed accordingly by the court, to be noted, to be considered seriously and to be included in the decision-making process. When submitting a private report, an unlawful submission can be made “into the blue”; cannot be affirmed if, according to the judge’s assessment, the private report fails to meet the standard of proof that is to be demanded in accordance with Section 286 of the German Code of Civil Procedure for convincing the truth of an allegation.

Task of the medical expert

Medical expert reports serve to clarify ambiguous medical facts to the extent that the legal questions associated with them can be answered. In order to comply with the rules of evidence of the legal system, the medical expert must limit his report to reliable medical knowledge. Only the objectively verifiable - and thus also reproducible in the assessment ( reliability ) finding opens up the possibility of its assessment with regard to the legal consequences, i.e. in the event of damage. a. the justification of a one-off compensation or permanent pension benefit (if applicable, insurance benefit). Typical tasks of the medical expert in court are social judicial (e.g. disability , occupational disability or presence of occupational diseases ), civil law (e.g. testability or litigation ) and criminal law issues (e.g. cause of death in the context of forensic medical reports or culpability in the context of forensic-psychiatric issues Assessment). Furthermore, this includes the rejection or determination of a treatment error with any resulting compensation , fee reclamation and compensation for pain and suffering .

qualification

The preparation of a medical report requires special additional knowledge, skills and attitudes than the sole medical activity in the curative area. In order to be able to draw up an appropriate medical report that satisfies the rules of evidence of the legal system, the expert must have solid specialist medical knowledge and basic knowledge of insurance law. He should be trained to replace the curative (healing) perspective with a cause-determining perspective. He can thus offer the medical laypersons involved in the procedure, who are to draw legally effective conclusions from health deficits or their fault-related causes, a basis for decision-making. Medical and dental experts are usually licensed doctors.

The knowledge required for this activity is mainly imparted postgraduate alongside work. In German-speaking countries, there are various further training courses and an academic qualification option. The University of Basel offers a postgraduate master’s degree in insurance medicine that is interdisciplinary and trinational (Switzerland, Germany, Austria).

Evidence

The report and the testimony of an expert are evidence if the court has appointed the expert. The court is not bound by the expert's conclusions, but freely appreciates his statements. According to Section 411a of the German Code of Civil Procedure ( ZPO), an expert report that has already been drawn up in another procedure can be used as an expert report (and no longer just as documentary evidence ) for the ongoing process. If necessary, the expert has to deal with already available reports and justify why he is following or contradicting an earlier report. It is at the discretion of the court whether the expert only submits his report in writing or whether he also presents and explains it orally in the hearing ( Section 411 ZPO).

Expert witness

The expert is to be distinguished from the expert witness . The borderline between the activity as a witness and that as an expert depends on whether it is only a matter of declaring facts that one has perceived on the basis of special expertise (then an expert witness) or whether one is asked to take account of facts on record or oneself to also evaluate a question (then an expert).

Psychological reports

For questions relating to family law, the working group “Family Law Reports” recommends a degree in medicine or psychology as a minimum requirement for the expert, as well as the acquisition of further relevant knowledge.

Expert opinion for chronic pain

The assessment of pain is an interdisciplinary medical task and requires competence to assess both physical and mental disorders. This results in two steps for the assessment process:

  • First, assess the proportion of pain that can be explained by damage to the nervous system and other types of tissue.
  • If there are indications of a psychological comorbidity, a psychiatric or psychosomatic assessment should also be carried out.

To this end, the German Society for Neurology (DGN) and the German Society for Neuroscientific Assessment eV have developed AWMF guidelines for the medical assessment of people with chronic pain.

Requirements for an expert opinion

The decisive part of the expert opinion is the findings.

Diagnosis before therapy

First of all, in the event of a dispute about a treatment error, the findings must be assessed by the expert before the disputed treatment. For this purpose, depending on the treatment case, he consults the:

Post-therapy findings

Determination of the state of health at the time of the assessment based on:

  • Diagnosis
  • Laboratory results
  • X-ray, CT, MRT images,
  • Scintigraphy, sonography, photos

As part of the assessment, the expert not only has to explain what positive findings he was able to determine, but also whether all other relevant aspects are of no relevance ("o. B." = no findings). The expert prepares the expert opinion from the comparison of the initial findings with his own examination findings and the assessment of the diagnostic and therapeutic procedures in between. He compares the measures taken with the scientific standard valid at the time of therapy. However, the expert opinion is subject to the free assessment of evidence by the court. Although the expert has a strong influence on the course of the proceedings, it does not make him a judge himself.

An expert opinion is

  • complete, if it answers all questions asked by the court (if these were admissible),
  • Comprehensible if the opinion can be understood by the court and can examine and assess the thought processes of the expert, which led from the finding to the expert opinion, and
  • conclusive if, after checking for completeness and traceability, it still appears convincing and free of contradictions (if different opinions are admissibly represented on a scientific dispute, the expert must explain why he is based on one argument and not the other).

Party public

The principle of party publicity according to Section 357 of the German Code of Civil Procedure (ZPO), according to which the parties are allowed to attend the taking of evidence, is controversial when a person is examined by a medical expert.

The human dignity of the person to be examined has a higher weight. This is the general opinion in literature and jurisprudence . It is therefore not necessary to notify one of the litigants of an appointment to physically examine the other litigant.

However, the Higher Regional Court of Frankfurt decided exactly the opposite in its decision of January 10, 2011. The right to preserve the patient's privacy, and thus the protection of personal rights , was weighed against the right of the party public when taking evidence . In principle, the right of the party public was given priority over the right of personality. With the present decision, the OLG Frankfurt differs from those in the appeal procedure because of bias adopted decisions of the Munich Higher Regional Court of 15 October 1999 (1 W 2656/99), the Cologne Higher Regional Court of 25 March 1992 (27 W 16/92, NJW 1992, 1568) and the OLG Hamm from July 16, 2003 (1 W 13/03). The Senate has therefore approved the appeal on points of law pursuant to Section 574 I No. 2 ZPO (here to the BGH ) to ensure uniform jurisdiction.

This means that the medical expert should ask the competent court until the supreme court ruling whether he can examine the patient alone without the parties involved - as is usually the case - whether he should inform both parties about the examination date and how he has to act if the patient refuses the presence of a litigant.

Decision to take evidence

In civil proceedings, the expert must strictly adhere to the decision on evidence. Otherwise, he runs the risk of being removed from the proceedings due to bias through an application by one of the parties to the proceedings. The expert does not have to present and appreciate “the whole truth”, but only medically evaluate the factual presentation that is recorded in the decision to take evidence, even if he or she should notice other facts when examining the case. If he were to describe these additional facts without being asked and thus provide one party with advantages, he is considered biased. For the result of an assessment, therefore, a. the questions of evidence that a party to the proceedings puts under expert evidence.

Dental expert

In the dental field, a distinction must be made between contract dental experts and private or court experts.

Contract dental experts

The contract dental experts are appointed by mutual agreement by the Association of Statutory Health Insurance Dentists (KZV) and the health insurance companies . The appraisers are appointed for a four-year term, but different terms of office can be agreed at the overall contract level. If the reviewer is appointed for the first time, either side can withdraw their consent within the first year. Otherwise, the reviewer is deemed to have been appointed for the current term of office.

The appraisal procedure is regulated for the primary health insurers in the federal contract dentists (BMV-Z) or for the substitute insurers in the substitute health insurance contract. A standardization of these two federal contracts is currently being negotiated between the National Association of Statutory Health Insurance Dentists and the National Association of Statutory Health Insurance Funds. In a first step, the expert system was standardized with effect from April 1, 2014. The reviewers can be recalled by mutual agreement. There are experts for the replacement insurance area, who are appointed by the respective state KZV and the replacement insurance funds (e.g. TK, Barmer, DAK), and experts for the primary insurance area (e.g. AOK, BKKen, IKKen) who are between the Landes-KZV and the respective cash register types. Assessments are responsible for cash handling. The assessments are free of charge for the patient. The health insurance fund generally bears the costs of the assessment. In the case of a complaint procedure, the dentist can be called upon to cover the costs of the initial assessment.

Order at federal level

The appointment of the experts and senior experts for implantology and the senior experts for periodontics and orthodontics is carried out by the National Association of Statutory Health Insurance Dentists in agreement with the central associations of the health insurance companies. Each state KZV suggests experts for this.

Order criteria

A contract dental expert must be licensed as a contract dentist in addition to his license to practice medicine. Furthermore, he must have worked as a contract dentist for at least four years and must not have been conspicuous in terms of professional law , his accounting behavior, or his own notification procedures. The contract dental experts are appointed separately for the specialist areas of dental prosthesis treatment, periodontal treatment and orthodontic treatment, and also for the exceptional indications for implant treatments. They must be able to prove their special qualifications for the respective specialist areas through relevant further training and appropriate treatment experience.

Assessment by the medical service of the health insurance companies

In the cases specified by law or if it is necessary due to the type, severity, duration or frequency of the illness or the course of the illness, the health insurance companies are obliged to provide services, in particular to check the prerequisites, type and scope of the service, and in the event of abnormalities to check the proper billing, to obtain an expert opinion from the medical service of the health insurance (MDK). Section 275 (1) SGB V. It follows that the health insurance companies may not commission an expert of their choice. According to the express will of the legislature, § 275 comprehensively regulates the assessment for contract dental care exclusively by the medical service, and therefore also for implant supplies and orthodontic treatments . The federal contract for dentists (BMV-Z) regulates in § 2 a paragraph 9 sentence 2 that the provisions of §§ 275, § 276 SGB ​​V remain unaffected.

Changes due to the Appointment Service and Supply Act

With the provision in § 87 paragraph 1c SGB V of the Appointment Service and Supply Act (TSVG), which was passed on March 14, 2019, an authorization basis for the commissioning and implementation of the expert procedures provided for in the federal contract for dentists and thus one of § 275 ff. SGB ​​V created deviating task regulation. The contract dental expert procedure has been established for decades in the field of dental prosthesis and orthodontic care. In the course of the Patient Rights Act, Section 13, Paragraph 3a, Clause 4 of the Book of the Social Code (SGB V) lists the possibility of carrying out the contract dental expert procedure within the prescribed processing period for applications for reimbursement by the health insurance companies. However, there has been no express authorization to carry out the contract dental expert procedure so far. Current case law has pointed this out and therefore considered the contract dentist's expert procedure to be inadmissible (BayLSG, judgments of June 27, 2017, Az .: L 5KR 170/15 and L 5 KR 260/16). This has now been clarified in the Appointment Service and Supply Act.

Planning report - defect report

A distinction must be made between so-called planning reports and defects reports when preparing reports:

  • The SGB V prescribes a compulsory assessment for more complex dental prosthesis treatments before the start of the treatment. In addition, the health insurance companies can have an assessment carried out before starting periodontal treatment or before orthodontic treatment , on which the reimbursement of costs depends.
  • In the so-called defect assessment, a treatment is checked for technical defects. If there are any, the treating dentist has to reimburse the treatment costs to the health insurance company. The patient's contribution may have to be reclaimed in proceedings before the civil courts if the patient's contribution is not reimbursed to the patient by the dentist. The same applies to claims for damages and compensation for pain and suffering, unless these are covered by the dentist's liability insurance.

Possibility of objection

You can object to a contract dentist's report. A further expert opinion can be requested from a senior expert or from the prosthetics approval committee. It is the responsibility of the general contracting parties at the state level to agree on a procedure. The prosthetic cleaning committee is different in the individual state KZVs, but always equally , made up of dentists and health insurance representatives.

statistics

Expertise is very important in the dental contract area. This is clear from the statistical figures for Germany. Planning reports are mainly prepared, which serve as the basis for the assumption of costs by the respective health insurance company. All reports contained in the tables were drawn up by experts appointed by mutual agreement between the health insurance companies and the dental associations.

Dental expert procedure 2011 in the area of ​​the statutory health insurance

Area of ​​Expertise Case number
2011		 Expert opinion *
2011		 Case number
2012		 Expert opinion *
2012
dentures 10,300,000 141,747 9,900,000 134,755
Periodontics 971,500 17,852 981,000 15,818
Orthodontics   60,280   64.127
Implantology **   2,296   2.191
  • mainly planning reports for approval by the health insurance company
    • only in the case of exceptional health insurance benefits

Dental prosthesis expert procedure 2012 in the area of ​​statutory health insurance

Area of ​​Expertise Number of treatment cases in
2012		 Report
2012		 of which planning reports of which defect report Defects found Defects in percent
dentures 9,900,000 134,755 118.274 16,681 11,276 0.11%

The dental prosthesis treatments that were objected to by experts were largely remedied by reworking or making new dental prostheses free of charge.

Deadlines for the assessment of benefit applications

An expert opinion that is provided for in the Federal Cover Agreement - Dentists (BMV-Z) or Substitute Insurance Contract - Dentists (EKV-Z) and which is usually drawn up by a resident dentist, for example when applying for approval of a treatment and cost plan for the supply of dentures or dental crowns, orthodontic treatment, the systematic treatment of periodontal disease or the exceptional indications for implant treatment according to Section 28, Paragraph 2, Sentence 9, SGB V, according to Section 13, Paragraph 3a, SGB V, this must be submitted within four weeks. These deadlines were newly introduced by the law to improve patient rights . If the MDK assesses, for example, a treatment and cost plan drawn up by a dentist with regard to the need for care, the report must be prepared within three weeks.

Private and court dental experts

The dental associations compile lists of “recommended experts” who are responsible for private expert opinions and who are subject to expert regulations. Private reports are important in the private dental field when it comes to clarifying treatment errors in private treatments or an inadmissible private bill according to the fee schedule for dentists (GOZ). Courts use these registers when they appoint an expert in proceedings to provide them with technical support in making a decision. However, the courts are not bound by such registers. Every dentist is de jure an expert in the field of dentistry due to his license to practice medicine . In the opinion of the Dental Associations, however, higher demands are placed on an expert than just the license to practice medicine: the expert must have sufficient professional experience, he must be able to explain complex dental issues to laypersons (parties involved in the proceedings such as judges, lawyers) in an understandable manner. He has to know the most diverse treatment variants, including those that he does not use himself, he has to know the current state of "dental art" at the time of treatment and be able to assess the causality between incorrect dental treatment and the patient's state of health. Reports are also created to assess disputed billing issues ( fee reports ).

In Bavaria there has been an Association of Bavarian Appraisers for Dentistry, Oral and Maxillofacial Medicine eV (VBGZMK) since 2003, in which dental experts from all disciplines have come together.

Advisory dentists

Consultation dentists are provided by private health insurances as well as by statutory health insurances and the medical service of the health insurance companies . You are either freelance or employed by these institutions. Your - especially financial - independence is therefore often called into question. Most of the time, their assessments are based on the files, without a physical examination. In the vast majority of cases, they are concerned with assessing benefits under the law, i.e. whether and to what extent the insurer pays.

Second opinion centers

Numerous dental associations and dental associations hold second opinion centers or advice centers where patients can obtain a neutral second therapeutic opinion. Most of these positions are filled with experienced experts who advise the patient free of charge. To ensure their neutrality, they are subject to a treatment ban on the patients they advise.

This must be distinguished from commercial (dental) medical auction portals, which, under the term second opinion point, merely provide opportunities to compare costs with low-cost providers - usually for a commission.

neutrality

According to a 2014 study by the Ludwig Maximilians University in Munich , every fourth surveyed medical expert had received a tendency from the judiciary; among the psychiatrists it was every third, among the psychologists every second.

Liability of the expert

In the case of an incorrect opinion, an expert appointed by a court is liable according to § 839a BGB - regardless of an oath - only in the event of willful intent and gross negligence for damage caused to a party involved in the proceedings as a result of a materially and legally incorrect judicial decision based on this opinion ( so-called judgment damage). Liability extends to financial losses, such as underestimated compensation for pain and suffering due to the incorrect factual findings in the report or overestimated litigation costs. In addition, the limited standard of liability also applies to damage caused by interference with absolute legal interests (e.g. physical integrity, freedom), for example in the event of a court order of a custodial measure based on a false opinion. Here compensation for pain and suffering comes into consideration.

The limitation of liability to gross negligence and intent serves the protection and independence of the expert who, according to the procedural rules of procedure (e.g. § 407 ZPO), is regularly obliged to provide the expert opinion and who cannot agree on a limitation of liability due to the lack of a contractual relationship with the parties. The liability rule does not apply if the procedure has not been decided by a court, i. H. is terminated by settlement or withdrawal of the action , as in these cases the causality for a possible occurrence of damage is usually missing.

In addition, the expert can be punished with imprisonment for a term of between three months and five years for false, unofficial testimony according to § 153 StGB or for perjury according to § 154 StGB .

If the expert is not appointed by a court, but by an authority or another public-law institution within the framework of an administrative procedure, liability for exclusively sovereign activity is based on the official liability principles of Section 839 . This is e.g. This is the case, for example, with official doctors as civil servants from the health department and medical officers from social insurance institutions, such as the professional associations.

In arbitration proceedings, the appointed expert has a contractual relationship under private law with the parties on whose behalf the arbitral tribunal issues the expert opinion. In this case, he is unrestrictedly liable like a private appraiser according to the general provisions of Paragraphs 634 and 280 f. for damages.

Medical liability insurance

With the entry into force of the Patient Rights Act , the suspension of the license to practice medicine can be ordered if the professional liability insurance of a doctor or dentist is inadequate . This is to ensure that the injured patient can be financially compensated even if the doctor has insufficient creditworthiness or liquidity. In view of the various liability circumstances that can arise from liability as a medical expert, occupational insurance cover should also include the activity as an expert.

Reward

The remuneration of court experts is based on the Judicial Remuneration and Compensation Act (JVEG)

Otherwise the remuneration is freely negotiable. If there is no express agreement, the remuneration is to be determined according to a possibly existing estimate, the usual remuneration according to § 315 BGB (reasonable discretion) or the additional contract interpretation.

Sales tax for reports

Unless an exemption from sales tax is explicitly defined by law, the service provided is regularly subject to sales tax. This also applies to medical reports. The basis is § 4 No. 14 UStG . The EU regulation in Article 13 (1) (c) of the 6th Directive 77/388 / EEC on the harmonization of sales tax, which is valid as a superordinate law , is activity-related, i.e. it only exempts certain individual services and thus sets the limits of tax-free activity significantly narrower. The tax offices also make different decisions nationwide which of the numerous types of medical reports are subject to VAT and which are VAT-exempt.

Age limit

The Federal Administrative Court in Leipzig has ruled that a general age limit represents an inadmissible disadvantage based on age under the General Equal Treatment Act (AGG) and is therefore ineffective. A Chamber of Commerce and Industry (IHK) is therefore not generally allowed to set a maximum age limit in its statutes for all publicly appointed and sworn experts (in this specific case, the maximum age limit of 68 years, which was provided for in the Expert Ordinance (SVO)).

Advertising by an expert

According to the case law of the Federal Constitutional Court (BVerfG), regulations restricting advertising are permitted in (dental) medical professional regulations , provided that they prohibit all advertising , only illegal advertising . If the information is in line with interests, is appropriate and does not cause any error, there must be room for it in legal and business dealings. For this reason, a (dental) doctor may only be prohibited from using a certain term to describe his professional activity if the use of the formulation is misleading or objectively inappropriate in a specific case, for example because it endangers the necessary relationship of trust between doctor and patient.

Military medical assessment and military service damage proceedings

The Institute for Military Medical Statistics and Reporting of the Bundeswehr (WehrMedStatInstBw) has taken on the tasks of medical assessment and military service damage procedures within the Bundeswehr, as well as the area of ​​ODIN Bw / Lung and TBC care.

literature

Individual evidence

  1. ↑ BverfG NJW 1997, 122
  2. ^ BGH of February 20, 2002
  3. ↑ German Lawyers Association. Working group on medical law: ... Spring meeting of the working group for medical law in the German Lawyers' Association . BoD - Books on Demand,, ISBN 978-3-89811-089-1 , pp. 3–.
  4. ↑ Archived copy ( memento of the original from June 21, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.unispital-basel.ch
  5. ↑ https://www.rak-berlin.de/download/lösungen_pdfs_skripten/Famrechtl_SV_Gutachten_Delerue_2015.pdf
  6. ↑ Medical assessment of people with chronic pain in: AWMF online (as of 2012)
  7. ↑ See findings
  8. ↑ Stadler in Musielak, ZPO, 2012, § 357 ZPO Rd.Nr.4; OLG Munich NJW-RR 1991, p. 896
  9. ↑ OLG Frankfurt, 22 civil senate, file 22 U 174/07
  10. ↑ a b Reorganization of the review system in zm-online issue 6/2014
  11. ↑ a b Federal Contract for Dentists BMV-Z, KZBV (PDF file; 232 kB)
  12. ↑ Az .: L 5 KR 260/16 Judgment of the Bavarian State Social Court of June 27, 2017. Retrieved on August 18, 2017.
  13. ↑ Az .: L 5 KR 170/15 Judgment of the Bavarian State Social Court of June 27, 2017. Accessed on August 18, 2017.
  14. ↑ Bundestag printed matter 15/1525, p. 141, on No. 155 justification of the law of September 8, 2003, German Bundestag. Retrieved August 18, 2017.
  15. ↑ Federal Shell Contract Dentists ( Memento of the original from August 18, 2017 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , April 1, 2017. Retrieved August 18, 2017. @1@ 2Template: Webachiv / IABot / www.gkv-spitzenverband.de
  16. ^ National Association of Statutory Health Insurance Dentists, Annual Report 2011/2012
  17. ↑ KZBV Annual Report 2012/2013
  18. ↑ Expert regulations of the BLZK, Bayerisches Zahnärzteblatt (PDF file; 89 kB)
  19. ^ Association of Bavarian experts for dentistry, oral and maxillofacial medicine eV (VBGZMK)
  20. ↑ Second opinion offices of the Bavarian Association of Statutory Health Insurance Dentists (KZVB)
  21. ^ BR Controversy of April 2, 2014, accessed April 6, 2014
  22. ↑ Benedikt Jordan and Ursula Gresser: THEMEN DER ZEIT - Court opinion: Often the tendency is given , Deutsches Ärzteblatt 2014; 111 (6): A-210 / B-180 / C-176, accessed April 6, 2014
  23. ↑ BGH April 4, 2006 - X ZR 122/05.
  24. ↑ Medical text online, doctor and sales tax (PDF; 336 kB) p. 2–5, medical reports subject to sales tax and exempt from sales tax.
  25. ↑ BVerwG, judgment of February 1, 2012 ( Memento of the original of March 22, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Az. 8 C 24.11, full text. @1@ 2Template: Webachiv / IABot / www.bverwg.de
  26. ↑ BVerwG, press release No. 9/2012 of February 1, 2012.
  27. ↑ BVerfG, decision of July 14, 2012, AZ: 1 BvR 407/11; Decision of March 7, 2012; AZ: 1 BvR 1209/11