The German Scale of Medical Fees (GOÄ) also applies to contracts with legal entities.

The ruling was based on a patient's claim against a university hospital for reimbursement of the fee for a high-energy precision radiation treatment of a prostate carcinoma (so-called cyberknife treatment). This innovative treatment method, which is generally carried out on an outpatient basis, is not included in the benefits catalog of the statutory health insurance funds and is therefore not included in the EBM. The plaintiff, who has statutory health insurance, is not a member of a health insurance fund that pays for Cyberknife treatment under special agreements with certain service providers. The plaintiff and the defendant university hospital had unsuccessfully applied to the health insurance fund to have the costs covered, whereupon the plaintiff agreed in writing to pay the costs of € 10,633.00 after the treatment. After five outpatient radiation appointments, the plaintiff asked the defendant to invoice him in accordance with the GOÄ. The hospital invoiced him the agreed amount as a lump sum, which the plaintiff paid. His claim for reimbursement of the treatment costs was successful in the lower courts.

The appeal by the university hospital was unsuccessful. The Federal Court of Justice (BGH) ruled that the agreement on the flat fee did not meet the requirements of Section 2 (1) and (2) GOÄ and was therefore void. As the defendant had also not calculated the costs according to the GOÄ (analogously), the plaintiff could reclaim the treatment costs according to the principles of unjust enrichment.

The GOÄ is to be applied to outpatient medical services where the service provider is a legal entity (such as a hospital operator) and the services are provided by employed or civil servant doctors. According to Section 1 GOÄ, the only prerequisite for the application of the fee schedule is that remuneration is claimed for the professional services of a doctor. This interpretation is supported by the broad wording of Section 1 (2) GOÄ and Section 11 sentence 1 BÄO (Bundesärzteordnung), but also by the meaning and purpose of the GOÄ regulations, namely the maintenance of reasonable fees for medical services for both parties. It is not recognizable that the liquidation of outpatient medical services should remain unregulated if a legal entity is the contractual partner of the patient, especially since the mandatory price law for medical services could otherwise be circumvented. Nor does the obligation to provide services personally stand in the way of this interpretation.

Furthermore, the BGH discusses why a flat fee is not compatible with the remuneration system of the GOÄ according to point numbers and values, which may not be changed by contract, as well as incremental rates.

However, the patient is not entitled to claim damages for failure to provide economic information (Section 630c (3) sentence 1 BGB in conjunction with Section 280 (1) BGB). The doctors at the university hospital were not obliged to inform the plaintiff that other health insurance companies would cover the costs of the Cyberknife procedure on the basis of separate contracts and that the plaintiff could have changed health insurance companies. § Section 630c para. 3 sentence 1 BGB merely obliges the treating party to inform the patient in good time before the start of treatment about the costs likely to be incurred in order to protect him from financial surprises and to show him the economic consequences of his treatment decision. However, the practitioner is not obliged to provide comprehensive financial advice, for example about a change of health insurance provider.