Une clinique ne peut pas demander l’annulation d’un arrêté relatif à la rémunération des médecins

FlickR - Radiologie - Leo ReynoldsQui a dit que dans la relation unissant les cliniques privées et les médecins libéraux y exerçant, c’était la négociation permanente ? L’affirmation est parfaitement vraie. Elle n’empêche pas, pour autant, les établissements de santé privés dits lucratifs de se soucier, de temps en temps, des intérêts de « leurs » médecins. En l’espèce, la spécialité concernée est la radiologie et l’objet du litige le fameux avenant n°24 à la convention nationale des médecins généralistes et des médecin spécialistes, qui fait tant couler d’encre, concernant surtout l’option archivage, dont les enjeux ont été décrits ici même.

Il ne s’agit pas ici d’archivage mais de rémunération des forfaits techniques des examens médicaux de scanner et d’imagerie à résonance magnétique effectués par les médecins libéraux.

Qu’on en juge ((CE, 21 juillet 2009, Polyclinique Les Fleurs, n°313489, AJDA 2009, p.2246.)) :

« Considérant que la POLYCLINIQUE LES FLEURS demande l’annulation de l’arrêté du 10 septembre 2007 du ministre de la santé, de la jeunesse et des sports et du ministre du budget, des comptes publics et de la fonction publique en tant qu’il approuve les stipulations de l’article 2 de l’avenant n° 24 à la convention nationale des médecins généralistes et des médecins spécialistes, lequel procède notamment à une réduction des forfaits techniques des examens médicaux de scanner et d’imagerie à résonance magnétique effectués par les médecins libéraux ;

Considérant que la liste des actes et prestations fixée par l’Union nationale des caisses d’assurance maladie sur le fondement de l’article L. 162-1-7 du code de la sécurité sociale dans sa rédaction applicable à la date de l’arrêté attaqué prévoit notamment que « les actes de scanographie, de remnographie, de tomographie à émission de positons sont rémunérés par l’addition d’un tarif par acte, figurant en regard du code, et d’un forfait technique rémunérant les coûts de fonctionnement de l’appareil installé […] » ; que ce forfait technique, alors même qu’il a pour objet de couvrir les coûts d’utilisation et d’entretien des appareils de scanographie, de remnographie et de tomographie à émission de positons, revêt le caractère d’une rémunération du médecin radiologue et non de l’établissement de santé au sein duquel, le cas échéant, il exerce ; que par suite, alors même que les forfaits techniques seraient directement versés à la POLYCLINIQUE LES FLEURS et conservés par elle en vertu des relations de droit privé qui la lient aux radiologues qui utilisent les équipements en sa possession, celle-ci ne justifie pas d’un intérêt suffisamment direct lui donnant qualité pour demander, dans la mesure mentionnée plus haut, l’annulation de l’arrêté litigieux ; que sa requête est donc irrecevable ; »

Le Conseil d’Etat n’a visiblement pas été convaincu par l’argumentation de l’établissement de santé qui, il est permis de le penser, n’a pas agi par pure philanthropie à l’endroit de « ses » radiologues, en contestant la légalité de l’arrêté d’approbation considéré. Au plan de la recevabilité de la requête, l’intérêt pour agir n’est pas apparu de manière manifeste aux yeux des Juges du Palais Royal, alors que l’arrêté attaqué emporte des conséquences financières directes sur la trésorerie de l’établissement requérant.

Certains points, que la décision du Conseil d’Etat n’aborde pas, mériteraient cependant d’être clarifiés :

s’agissant en premier lieu des relations juridiques exactes unissant les radiologues à l’établissement, ce dernier les présentant par exemple sur son site comme, en quelque sorte, des « praticiens hospitaliers » exerçant dans un service, alors qu’en réalité les médecins radiologues sont des libéraux associés dans une société civile de moyens. La différence est mince, au regard du public profane ; elle l’est moins du point de vue juridique en cas de litige : un contrat doit certainement exister entre les deux entités.

s’agissant en second lieu des relations financières : qui verse quoi à qui ? Et réciproquement.

A l’heure où la FHF et la FHP s’invectivent sur la question de la pertinence des actes et de l’éventuel contrôle, par la Cour des comptes, de la comptabilité des cliniques privées, il serait de bon ton d’appliquer la transparence de ce type de rapport auprès du public.

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