Clawback mechanism – A brief overview


The clawback mechanism was introduced by the Greek legislator as part of the general effort to reduce the public debt and to support the exit of the national economy from the crisis.  More specifically, in accordance with Article 100 of Law 4172/2013, the following have come into effect since July 2013 (with a retroactive effect from 01/01/2013):

An automatic claw-back mechanism for any expenses incurred relating to (a) hospitalization, diagnostic tests and physiotherapy and (b) provision of medical products and dietary supplements. Based on this mechanism, the monthly National Organization for Healthcare (EOPYY) expenses offered in case (a) above by affiliated private healthcare providers and in case (b) above by manufacturers, importers, distributors/suppliers affiliated with EOPYY must not exceed a certain limit of the approved credit funds of the EOPYY budget. The excess amount claimed on EOPYY’s part from the above persons is calculated on a semi-annual basis and must be deposited in a bank account indicated by EOPYY within one month from the date of issuance of the written personal notification. If said deadline expires without the payment having been made, the EOPYY Board of Directors terminates the contract between EOPYY and the above persons automatically and without payment of compensation until such time as the total amount due has been paid with interest by the provider or has been collected in accordance with the provisions of the Public Revenue Collection Code (KEDE). The monthly invoice submitted to EOPYY is used to calculate the claw-back amount corresponding to each person above per month. Expenses submitted to EOPYY 20 days after the end of each month, and which relate to services rendered during the previous month, are neither recognized nor paid by EOPYY.

The total claw-back amount is calculated semi-annually, by calculating the difference between the budgeted and the actual expense arising from the amount claimed by the provider, once any rebate and other expenses unacceptable at the time of calculation have been subtracted.

In accordance with Article 25 of Law 4549/2018, the claw-back mechanism of Article 11 of Law 4052/2012 of the Ministerial Decision No. Γ5/63587/2015 and Article 100 of Law 4172/2013, as amended and in force, is extended to the years 2019-2022, whereby 2018 is the initial basis of calculation for the first application, while the basis of calculation for any subsequent years will be the respective previous year. The permitted expenditure limits are adjusted for the years 2019-2022 exclusively based on the forecasted annual change of the real GDP at fixed prices, as reflected in the annual budget. The distribution of the limits among the three expenditure subcategories are depicted in the recommendation report of the annual Greek budget. For the first implementation and as regards the year 2019, the distribution of the limits for the EOPYY pharmaceutical expenditure, hospital medication expenditure and expenditure for healthcare services provided by EOPYY are determined by Ministerial Decision No. B2, B2/101439/2019 which sets the limit for the EOPYY pharmaceutical expenditure at 1.945 m. euros, hospital medication expenditure at 569 m. euros and expenditure for healthcare services provided by EOPYY at 1.510 m. euros.

A recent legislative development namely the enactment of Law 4647/2019 (Government Gazette n. 204/A/16-12-2019), introduces a new provision on the settlement of debts from clawback. More specifically, according to article 10 of the law, any outstanding amounts against the Greek National Health Service Organization (EOPPY), arising from the implementation of the clawback provision for the years 2013-2019, may be paid in interest-free instalments, the number of which may extend to 120 instalments. Companies may be subject to this favorable provision for settling their debts provided that they waive any claim or legal remedies they have filed related to any outstanding amounts emanating from the rebate and/or clawback measures for the years 2013-2019.