Trick or Treat: Private clinics face lawsuits over paid emergency care
Russians have the right to receive free emergency medical care in private clinics connected to the compulsory health insurance program. But often in this situation, non-governmental medical institutions try to collect money for treatment from the patient, and not from the Compulsory Medical Insurance Fund, as required by law. In this regard, similar lawsuits are currently being prepared against three large private clinics, which can form a stable judicial practice in similar situations, Izvestia learned. The head of the State Duma Committee on Health Protection, Sergei Leonov, asked the Supreme Court of the Russian Federation to clarify whether Russians can receive emergency medical care for free in paid medical organizations. At the same time, the clinics have a different view of the situation: state compensation cannot cover all the costs of saving emergency patients, they claim.
Why did the deputy appeal to the Supreme Court
Sergei Leonov appealed to Igor Viktorovich Krasnov, Chairman of the Supreme Court of the Russian Federation, "to provide a clear explanation of whether a person has the right to receive free emergency medical care in a private clinic or not." He pointed out that the Constitution of the Russian Federation and Federal Law No. 323 "On the Basics of Public Health Protection" guarantee this right, even if assistance is provided by a non-governmental organization. At the same time, there are cases when private clinics charge patients large bills.
Leonov explained to Izvestia that the topic arose due to the availability of court cases from people whose private medical institution demanded payment after receiving emergency care.
"There are already real civil cases about the recovery of money paid under the contract and compensation for moral damage," said the State Duma deputy. — Currently, law enforcement practice has not been formed, we need an explanation from the Supreme Court of the Russian Federation.
He added that according to 323-FZ, emergency medical care is considered to be that which is provided for sudden acute illnesses, conditions and exacerbation of chronic diseases. And the main criterion is the presence of a critical risk to life.
"This kind of assistance should be provided immediately and free of charge to every citizen," the source stressed.
Izvestia sent a request to the Supreme Court of the Russian Federation.
How private clinics charge money for emergency care
One of the high-profile stories occurred in September 2025, when the Moscow branch of the Israeli Hadassah clinic demanded 2.4 million rubles from relatives of a man who died in intensive care. This amount, according to the medical institution, ran up during the seven days he spent in the clinic. The patient's relatives claim that she initially contacted Hadassah to provide him with routine care. Already at the clinic, the man's condition deteriorated sharply. From that moment on, the medical facility was supposed to provide assistance free of charge. However, according to the family, in the intensive care unit, the patient was prescribed numerous expensive tests and procedures without approval, for which he was billed.
In response, the clinic referred to the fact that there was a contract with the customer for paid medical services, and the care was not "emergency", but "urgent". The demands of the relatives in Hadassah were called an "abuse of law."
Polina Gabai, the victims' lawyer, said that the legal and medical analysis showed that most of the care was of an emergency nature and the payment at the patient's expense was illegal.
This story is far from the only one, Gabay told Izvestia. According to her, she and several other lawyers are currently selecting a dozen similar cases to jointly file similar lawsuits against three clinics: Hadassah, which has the most such stories, Medsi and EMC.
— All these cases are of the same type: people come to receive routine medical care, but for one reason or another they end up in the intensive care unit of the clinic, and there they are "cured" for millions of rubles. If patients die, these bills are sent to relatives and if they are not paid, they are sued," the lawyer said.
She added that the State Duma Committee on Health Protection, as part of its work on the parliamentary publication ECHO of Medicine, sent requests to dozens of regions of Russia to find out how this system works in reality. It turned out that private clinics almost do not apply for compensation to the territorial compulsory medical insurance funds, despite the fact that appropriate mechanisms are provided in the regions.
— Firstly, because the compensation amounts are very small, this is not at all what private clinics offer to patients. Secondly, because the territorial funds will carefully examine what services were provided, whether there were medical indications for this or not," the Izvestia interlocutor said, adding that many medical interventions are devoid of any clinical value and are prescribed without indications.
And patients who have received bills from private clinics rarely go to court because they do not know that they are entitled to free emergency care even in non-governmental institutions by law, she said.
How clinics incur losses due to emergency care
At the same time, Polina Gabai admits that it is often difficult for private clinics to obtain fair compensation from the state, given that the rates for emergency care themselves rarely correspond to the real costs of medical institutions for treatment.
So, in April 2024, the courts refused to pay for emergency medical services to the MAKS-M private clinic in Kovrov (Vladimir region). The trial concerned eight patients with acute coronary syndrome. All of them were delivered to the clinic via the established ambulance routes, but the court granted payment for services only in the amount stipulated by the state guarantee program. The financial losses of the clinic are estimated at 1.7 million rubles for eight cases of treatment.
Alexey Goryainov, a medical lawyer, told about a similar case. He noted that some private organizations may shy away from the obligation to provide emergency care due to fears that insurers will not pay for it. Such a case in the lawyer's practice occurred in St. Petersburg and also concerned the provision of emergency care to patients with acute coronary syndrome.
— The private clinic faithfully fulfilled its duty and treated patients, bringing them back to life. Moreover, the quality of services was the highest. But the insurers refused to pay the clinic for medical services, even though they should have. I then managed to recover the bills from the insurers through the court," the Izvestia interlocutor gave an example.
After that, according to him, a stable judicial practice was established at the level of arbitration courts on the possibility of collecting payment from insurers for emergency treatment. However, even now, obstacles to clinics receiving payments appear regularly.
— And a paradox arises — the patient is on the verge of death, there is a wonderful private clinic nearby, there is a right to take the patient there and save him. But due to regional bureaucratic regulations that contradict higher authorities, the person will be taken to a state medical organization located on the opposite side of the city, wasting valuable time," Goryainov said.
Alexander Solonin, General Director of the Association of Private Clinics in St. Petersburg, explained that conflicts arise not because of the "greed" of private clinics, but because of legal and financial uncertainty.
"Emergency care should be provided free of charge, but free of charge for citizens, not for a medical organization," the Izvestia source emphasized. — Private clinics included in the compulsory medical insurance system can receive money from the territorial fund for this assistance, but often the tariffs are lower than the actual cost, and for clinics not included in the state guarantee program, there is no mechanism at all to compensate for the costs of expensive emergency interventions.
According to the expert, a patient with a stroke, heart attack, or life-threatening injury can come to any nearby private clinic, and doctors are obligated to help him. But at the same time, the clinic will incur real and often very high costs.
— The clinic finds itself between the hammer of the law, which requires help, and the anvil of economic reality, since there is no free medical care in terms of economic relations, — said Alexander Solonin. — It is either paid from citizens' taxes (budget), or from insurance premiums (compulsory medical insurance, VMI), or in cash.
Yan Vlasov, co-chairman of the All-Russian Union of Patients, added that many disputes arise at the moment of transition from the emergency stage to further treatment.
In turn, Yulai Magadeev, a member of the Board of the National Association of Healthcare Managers, president of the Medma group of medical companies, stressed that ambulances usually immediately send patients to organizations listed in the regional routing order. He is convinced that according to the existing norms, a situation where an ambulance brought a patient to a private center, and there they demand money or VMI insurance from him, "simply cannot arise."
Do I need to clarify the law enforcement practice
Polina Gabai stressed that there is no conflict of norms, all the provisions in the law are clearly spelled out. If private clinics are not satisfied with the procedure for providing compensation for emergency care, then they or associations of private clinics should discuss this with regulators, but not violate the law and not shift responsibility onto the shoulders of patients.
The Association of Private Clinics in St. Petersburg, however, is convinced that it is necessary to clearly define the rules for billing for emergency medical care. According to Alexander Solonin, judicial interpretation is not enough: a comprehensive legislative solution is important.
— It should be clearly divided: if a private clinic participates in the compulsory medical insurance program, it is obliged to provide emergency care free of charge for the patient, but the state must compensate these costs at economically reasonable rates, and not on a residual basis. If a private clinic is not included in the compulsory medical insurance register, its duty is to stabilize the patient's condition and immediately transfer him to the state ambulance or the nearest hospital operating in the compulsory medical insurance system," said the head of the association.
The interlocutor of Izvestia believes that an "extremely clear procedure" is needed for doctors in providing emergency care.: what is considered an emergency condition and what is a condition in which the patient can be transported to a government facility.
The boundary between these cases is "not too clear," and clearer definitions are needed in legislation, agreed Shamil Omarov, co-owner and chief physician of the Dr. Omarov Clinic.
In turn, Alexander Aronov, Chairman of the Committee on Legal Support of NAUZ, Chairman of the Presidium of ICA Aronov & Partners, argues that the assessment of the health status of a particular patient, including for the presence of a threat to life, "remains and will always remain at the discretion of the medical professional." According to him, it is impossible, and it is not necessary, to regulate this issue in legislation.
The mechanism of financial provision of emergency assistance requires additional adjustment, believes Yan Vlasov. It is important that a direct-action rule be created that guarantees compensation for the clinic's expenses, regardless of its status in the compulsory health insurance system.
"It is also obvious that clearer explanatory work is required and, possibly, the adjustment of by—laws in order to exclude double interpretation and cases of illegal collection of fees," he stressed.
At the same time, Yulai Magadeev claims that the procedure for providing medical care, including emergency care, is well regulated in Russian legislation. The main problem, in his opinion, is that "responsible people contrast the public health system with the private one, although all medical organizations are integral parts of the general health system." As a result, additional restrictions are created for both patients and private clinics that participate in the compulsory health insurance system.
Переведено сервисом «Яндекс Переводчик»
