Guide to SGK Contract Management and Penal Risks in Private Hospitals and Clinics

Administrative and Legal Risk Management in Private Health Institutions: How to Protect Yourself from SGK Penalties and Suspension of Activity Sanctions?

Providing health services for private hospitals, medical centers, and clinics is not only a medical operation management; it is also a risk management carried out within the highly dynamic and severely sanctioning regulatory circle of the Social Security Institution (SGK) and the Ministry of Health. In today’s healthcare sector, a systemic error, a missing notification, or a tiny procedural deficiency in physician records can lead you to face massive administrative fines calculated over the gross revenues of healthcare institutions, or even the risk of complete closure of your clinics.

However, the regulatory authority of the administration over health institutions is not unlimited. There are very important precedent decisions of high courts protecting the operational freedom of private health institutions. In this guide article, in light of current judicial decisions, we have discussed the critical operational rules, penal sanctions, and protective legal rights that private health facilities must comply with.

1. Operational Traps in SGK Health Service Contracts

The contracts signed between private healthcare providers and SGK are the main pillar of your hospital’s financial sustainability. However, extreme attention must be paid to three critical headings that are most penalized during audits:

• Medula System and Mandatory Physician Registration: It is a legal requirement that all physicians working in your health facility are fully registered in the Medula system. According to the established decisions of the Court of Cassation; employing a physician who is not registered in the system in any department, including the emergency room, is directly considered a breach and violation of the contract, regardless of whether the institution has suffered any concrete damage.
• Prohibition of Assigning “Private Patient” Status to SGK Patients: Institutions having a contract with SGK are obliged to accept eligible patients coming directly or by referral. According to high court jurisprudence, entering SGK patients into the system under “private patient” status and collecting the entire fee directly from the patient is considered a clear breach of contract.
• Branch-Based 60% Physician Requirement: Private healthcare institutions are obliged to contract with SGK for all branches included in their activity permit documents. According to the current decisions of the Council of State, it is required that active service is provided by at least 60% of the physicians working in each branch covered by the contract.

2. Cooperation with Private Practice Physicians and MBYS Notification Obligations

Annual contracts made by private hospitals with external physicians who have private practices create joint responsibilities both medically and administratively:

• Joint Legal Liability: The private practice physician and the private hospital administration are jointly (together) responsible for possible malpractice or compensation risks that may arise from the diagnosis and treatment services performed by external physicians in your hospital.
• Informed Consent Form with 4 Signatures: In order for the informed consent forms prepared before treatments and surgeries to be considered valid; it is mandatory that the form includes the signatures of the patient, the private practice physician, the relevant unit manager, and the responsible manager of the hospital.
• MBYS and Monthly Notification Obligation: Responsible managers must report the number of patients treated and the names of the relevant physicians to the Provincial Health Directorate as of the end of each month and issue detailed invoices to the patients. Failure to regularly share these data through the Examination Information Management System (MBYS) invites penalties to be deducted directly from gross income.

3. Severe Administrative Sanctions and Penalties Applied to Health Institutions

In case of violation of the legislation and SGK contract provisions, the penal sanctions to be applied by the administration are of a magnitude that will shake the monthly turnovers of hospitals. The sanction table reflected in current judicial decisions is as follows:

Detected Legislation / Contract Violation	Financial and Administrative Sanction to be Applied
Issuing false documents or invoicing for unprovided services	Penal clause equal to 5 times the transaction amount (not less than 10,000 TL).
Failure to keep records or comply with the MBYS notification obligation	Warning for the first two detections; if not complied with, an administrative fine of 1% of the previous month’s gross income.
Violations of personnel, medical device, and building standards	Administrative fine up to 5% of the health institution’s previous month’s gross service income.
Opening a new service unit/department without permission	Administrative fine up to half (50%) of the health institution’s previous month’s gross service income.
Repetition of legislation violations for the third time within a year	Suspension of the activity of the relevant department or the entire institution for up to 10 days.

4. Protective Rights of Private Hospitals: The Administration’s Planning Authority is Not Unlimited!

The Ministry of Health’s authority to plan, audit, and regulate the health sector is certainly not absolute and unlimited. The Council of State and the Court of Cassation have drawn very clear boundaries to protect the commercial and operational freedoms of hospitals:

NOTE: Precedent Council of State Decision: Quota Limitations are Unlawful Strict quota restrictions such as 15% or one-third brought by the Ministry of Health regarding the cooperations private hospitals will make with private practice physicians were found unlawful and annulled by the 10th Chamber of the Council of State on the grounds that they were not based on a scientific study and data. The administration cannot make restrictive regulations without concrete scientific data; otherwise, it is an exceeding of discretionary power.

Furthermore, the judiciary is very sensitive to allegations that patients are “directed” from public institutions to private hospitals. The fact that a patient chooses your private institution of their own free will due to long waiting times or intensity in public hospitals does not directly constitute a “crime of patient direction”; it is mandatory for the administration to present concrete and conclusive evidence in order to apply penal action.

5. Risk Management in KVKK, Telemedicine, and Institutional Transfers

• Security of Personal Health Data: Patients’ medical history, analysis, and examination results have the most critical “special category personal data” status. Full compliance with the provisions of KVKK (Personal Data Protection Law) No. 6698 must be ensured in the processing of this data and its transfer to central systems; otherwise, irreversible sanctions are applied during administrative judicial audits.
• Remote Health Services (Telemedicine): It is a legal obligation for institutions that will provide online examination and remote health services to use infrastructures registered by the Ministry of Health and to have an official activity permit issued in this field.
• Institutional Transfers with its Legal Dimension: In hospital, medical center, or clinic transfer processes, the employment contracts, severance, notice, and all acquired labor rights and debts of existing employees are legally transferred as they are to the acquiring new administration.

Secure Your Health Institution with Proactive Legal Auditing

As can be seen, penalties in health law are deducted on a percentage basis over the institution’s “gross service revenues” rather than being transaction-based. This situation can cause even a single procedural error to return to your company as invoices worth millions of liras or to damage the hospital’s brand value with 10-day activity suspension decisions. Instead of filing a lawsuit after penalties are issued, designing the processes in accordance with the legislation from the very beginning (preventive compliance) is the most rational corporate strategy.

As NS Law and Consultancy; we offer proactive health law consultancy for private hospitals, medical centers, and polyclinics. We protect your corporate rights in annulment lawsuits to be filed against unfair administrative fines and suspension of activity decisions applied by SGK/Ministry of Health.

To protect your company’s operational freedom, complete your financial risk analyzes, and put your institution under legal assurance, you can contact us to make an appointment through our communication channels.