Intensive care services
Medical treatment services
Medical treatment services provided by physicians are exempt from VAT (Section 4 No. 14 Letter a Sentence 1 of the German Value-Added Tax Act (Umsatzsteuergesetz/UStG)). It was previously disputed whether intensive care services provided by a GmbH in hospitals fall under this exemption provision. The German Federal Fiscal Court/BFH has now affirmed this (ruling dated April 21, 2021, XI R 12/19).
Physician-like service
The service provided in the dispute solely by the GmbH managing director - a registered nurse and intensive care nurse - is a "doctor-like service", which corresponds to the overall picture of medical treatment services, insofar as it is provided for the purpose of prevention, diagnosis or therapy. The tax office was of the opinion that the sales declared by the nurse as exempt from VAT were not exempt from VAT. This is despite the fact that the tax authorities in Section 4.14.4 Paragraph 11 Sentence 1 No. 4 Sentence 1 of the VAT Application Decree always assume tax-exempt sales in the case of nurses.
Conclusion
The exemption from VAT of activities performed by members of the medical profession should be examined in detail on a case-by-case basis. The tax authorities base their assessment, among other things, on whether the corresponding doctor-like service is financed by the social insurance institutions and whether suitable professional proof of qualification can be provided for the performance of the service. In the relevant ruling, the BFH also decided that tax-exempt medical treatment services are not to be counted towards the so-called small business turnover limit (Section 19 (3) UStG, turnover limit = € 22,000.00). This finding can be advantageous, among other things, if a GmbH (as in the case in dispute) also performs other services subject to VAT in addition to the care services.
Status: February 25, 2022
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