Frais d’hospitalisation litigieux : à la recherche du juge compétent

Photo personnelle - argentLes histoires de recouvrement de créances au profit des hôpitaux sont parfois affreusement compliquées en ce qu’elles font intervenir généralement une pluralité d’acteurs aux statuts juridiques différents, au point de se demander parfois quelle est la procédure adéquate et quel est le juge compétent.

L’arrêt évoqué ci-dessous illustre parfaitement ces difficultés.

Un patient, qui a effectué plusieurs séjours à l’hôpital de la Pitié-Salpêtrière, avait préalablement souscrit un contrat d’assurance auprès de la société Aquila Consultant pour couvrir le risque de maladie. C’est ainsi que la société a demandé aux services dudit établissement de santé, d’une part, de lui envoyer une nouvelle demande de prise en charge en cas de complication médicale susceptible de nécessiter une prolongation de séjour, d’autre part, de lui adresser directement les factures libellées au nom du patient souscripteur dont la prise en charge était contractuellement prévue.

Le trésorier-payeur général (TPG) – fonctionnaire le mieux payé de France, paraît-il – de Paris a émis, le 26 janvier 2006, à l’encontre de la société, un commandement de payer d’un montant de 139.443,91 € correspondant aux frais d’hospitalisation du patient. Bien entendu, la société d’assurance ne s’est pas montrée encline à désintéresser l’Assistance publique-Hôpitaux de Paris (AP-HP).

C’est ainsi qu’un litige est né devant le tribunal administratif de Paris.

Par jugement du 6 juillet 2007, les juges de première instance ont partiellement fait droit à la demande du TPG.

La cour administrative d’appel de Paris a donc été saisie par la société déboutée. La juridiction du second degré s’est prononcée sur deux points d’inégal intérêt.

Le premier concerne un point de procédure : le respect du principe du contradictoire. En effet, l’AP-HP a communiqué un mémoire en défense à la partie adverse le jour de la clôture de l’instruction, de sorte que la société défenderesse n’a pas été en mesure d’examiner les arguments et d’y répondre utilement. C’est un cas classique de communication tardive des écritures, qui curieusement n’a pas été pris en compte par les juges du tribunal administratif de Paris. Le jugement a donc été rendu au terme d’une procédure irrégulière.

Le second point est beaucoup plus intéressant. Pour étayer son argumentation, l’AP-HP s’est fondée sur un article R.716-9-1 du code de la santé publique, alors applicable, qui disposait (nous soulignons) :

« Dans le cas où les frais de séjour des malades ne sont pas susceptibles d’être pris en charge soit par les services d’aide médicale, soit par un organisme d’assurance maladie, soit par le ministère chargé des anciens combattants et victimes de guerre ou par tout autre organisme public, les intéressés ou, à défaut, leur famille ou un tiers responsable sosucrivent un engagement d’acquitter les frais de toute nature afférents au régime choisi. Ils sont tenus, sauf dans les cas d’urgence, de verser au moment de leur entrée dans l’établissement une provision renouvelable calculée sur la base de la durée estimée du séjour. En cas de sortie avant l’expiration du délai prévu, la fraction dépassant le nombre de séjours de présence est restituée ; »

Pour justifier le bien-fondé de son recouvrement, le TPG affirme que le commandement de payer trouve sa source dans l’engagement, au sens de l’article ci-avant énoncé, souscrit entre la société d’assurance et le patient.

Site de Pat. Seiler - dessin réalisé pour la MEAHPremière difficulté : l’existence de cet engagement manque en fait dès lors qu’il n’est établi par aucune pièce du dossier. Deuxième difficulté : le contrat conclu entre l’assureur et la personne hospitalisée constitue un contrat de droit privé. Troisième et dernière difficulté : la succession de correspondances échangées entre la Pitié-Salpêtrière et l’assureur est-elle de nature à caractériser un tel engagement ? Non, répondent les juges d’appel.

Ces difficultés n’ont pas échappé aux juges de la cour d’appel, qui ont purement et simplement annulé le jugement et ont renvoyé les parties à mieux se pourvoir, autrement dit en l’occurrence à se présenter devant le juge judiciaire, juge naturel des rapports de droit privé ((CAA Paris, 6 mai 2009, Aquila Consultants (Sté), n° 07PA03482.)).

On observera que la nouvelle rédaction de l’article R.716-9-1 du code de la santé publique (issue du décret n°2007-46 du 10 janvier 2007) désormais numéroté R.6145-4 du même code, est à la fois plus détaillée et plus précise (nous soulignons) :

« Dans le cas où les frais de séjour, les frais de consultations ou d’actes ou d’hospitalisation des malades ne sont pas susceptibles d’être pris en charge, soit par un organisme d’assurance maladie, soit par le ministre chargé des anciens combattants et victimes de guerre ou par tout autre organisme public, les intéressés ou, à défaut, leurs débiteurs ou les personnes désignées par les articles 205, 206, 207 et 212 du code civil souscrivent un engagement d’acquitter les frais de toute nature afférents au régime choisi. Ils sont tenus, sauf dans les cas d’urgence, de verser au moment de l’entrée du malade dans l’établissement une provision renouvelable calculée sur la base de la durée estimée du séjour, des frais de consultations, d’actes, ou d’un tarif moyen prévisionnel du séjour arrêté par les ministres chargés de la santé et de la sécurité sociale. Lorsque la provision versée est supérieure aux montants dus, la différence est restituée à la personne qui a versé la provision ».

Poétiquement désignés par l’expression « débiteurs d’aliments » , les personnes mentionnées aux articles 205,206, 207 et 212 du code civil sont respectivement : les enfants de la personne hospitalisée, les gendres et belles-filles, les créanciers et enfin le conjoint.

Sauf erreur ou omission, l’arrêté fixant la base de calcul de la provision n’est pas paru.

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