Der Freiberufliche Heilmittelerbringer. Vergütungsanspruch in der gesetzlichen Krankenversicherung E-Book
Steffen Salutzki
36,99 €
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- Herausgeber: GRIN Verlag
- Kategorie: Geisteswissenschaft
- Sprache: Deutsch
- Veröffentlichungsjahr: 2010
Diplomarbeit aus dem Jahr 2009 im Fachbereich Jura - Öffentliches Recht / Sonstiges, Note: 1,0, FOM Hochschule für Oekonomie & Management gemeinnützige GmbH, Berlin früher Fachhochschule, Sprache: Deutsch, Abstract: Gegenstand der Arbeit ist die Frage, ob ein freiberuflicher Heilmittelerbringer im System strenger gesetzlicher und untergesetzlicher Vorgaben für seine Leistungserbringung zu einer angemessenen Vergütung gelangen kann. Im Grundlagenanteil erörtert der Autor zu diesem Zweck die Begriffe des hier angesprochenen Heilmittelbereichs und der besonderen Leistungserbringer und stellt sodann die weiteren Akteure im System der gesetzlichen Krankenversicherung dar. Klar und übersichtlich wird geschildert, wer in diesem System „mitspielt“ und welche Rollen zwischen Krankenkassen, Verbänden, Vertragsärzten und Versicherten verteilt sind. Sodann wendet der Verfasser sich den sozialrechtlichen Grundzügen der Heilmittelerbringung zu und schildert die Zulassung des Heilmittelerbringers und ihre Voraussetzungen. Hierbei stellt er detailliert die Voraussetzungen des § 124 II SGB V i.V.m. den Empfehlungen des Spitzenverbandes Bund der Krankenkassen dar und geht an dieser Stelle auch auf das Abrechnungsverhältnis ein. Der Autor setzt sich eingehend mit der rechtlichen Einordnung des Abrechnungsverhältnisses auseinander und zeigt, welche Unterschiede sich zwischen öffentlich-rechtlicher und privatrechtlicher Bewertung gerade im Fall der Störung des Rechtsverhältnisses aus Sicht des Erbringers der Sachleistung ergeben. Auf dieser Grundlage untersucht der Autor im Folgenden den Vergütungsanspruch des freiberuflichen Heilmittelerbringers sowohl unter den Bedingungen eines für ihn geltenden Rahmenvertrages also auch ohne diesen. Im Ergebnis zeigt er nachvollziehbar auf, dass der freiberuflichen Heilmittelerbringer im geltenden Regelungsgeflecht kaum eine realistische Chance hat, im Rahmen seiner Unternehmensführung angemessene Preise für seine Leistungen zu erzielen. Gerade „herkömmliche“ Lösungen nach dem bürgerlichen Recht (z. B. § 313 BGB) scheitern aus verschiedenen Gründen. Der Autor skizziert zwei mögliche Auswege: einmal unter Inanspruchnahme einer Schiedsperson, zum anderen den Abschluss eines Einzelrahmenvertrages gemäß § 125 II SGB V mit den Krankenversicherungsträgern als Inhalt eines Schadensersatzanspruchs nach nationalem Kartellrecht.
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