New questions referred to ECJ on VAT exemption for medical services

The Belgian Court of Cassation has referred two preliminary questions to the European Court of Justice (ECJ) regarding the interpretation of Article 132(1)(c) of the VAT Directive, which exempts from VAT certain medical services provided by regulated professions.

The questions arise from a case involving a Belgian company, Drebers, that provides medical services through doctors and nurses who are not its employees, but work under contracts of collaboration or service provision. The company invoices its clients for these services and pays a fee to the doctors and nurses.

The Belgian tax authorities considered that Drebers was not entitled to apply the VAT exemption for medical services, as it did not meet the conditions laid down by the ECJ in its previous case law, namely that the services must be provided by a regulated profession and that there must be a direct link between the service provider and the recipient.

Drebers challenged this decision before the Belgian courts, arguing that it acted as an intermediary between the doctors and nurses and their clients, and that it did not perform any medical activity itself. It also claimed that the ECJ case law did not require that the service provider and the recipient be identical, but only that they belong to the same legal relationship.

The Court of Cassation decided to refer the following questions to the ECJ:

– Is Article 132(1)(c) of the VAT Directive to be interpreted as meaning that medical services provided by a taxable person who is not himself a regulated profession within the meaning of that provision, but who makes use of regulated professions within the meaning of that provision who are not his employees, but work under contracts of collaboration or service provision, may fall within the scope of that exemption?
– If so, does that exemption apply only if there is a direct link between those regulated professions and the recipients of those services?

The ECJ’s answers to these questions will have significant implications for the VAT treatment of medical services provided by intermediaries or platforms that engage regulated professionals. The case number is C-243/23.