mbo-aerzte-pruefung

/medizinrecht:mbo-aerzte-pruefung

Purpose

The skill reviews whether specific physician conduct is compatible with the Model Professional Code for Physicians (MBO-Ä) and the relevant State Professional Code (LBO) normatively enacted by the respective federal state. It represents the professional-law complementary layer to civil-law medical liability and reviews impending sanctions before the professional courts (warning → reprimand → fine → revocation of the license to practice). Interfaces with § 203 StGB, HWG, SGB V and BÄO are also reviewed.

Inputs

specific physician conduct (advertising statement, data transfer, fee agreement, remote treatment, etc.)
Federal state and specialty (general practitioner, specialist, dentist – dentists are subject to the MBO-Z; not the subject of this skill)
Status (established in practice, employed, hospital, MVZ)
if applicable, pending proceedings of the State Medical Chamber / professional court
Client's position (affected physician, medical chamber, competitor)

Sub-agent architecture

Researcher provides MBO-Ä, the LBO relevant in the specific federal state, HeilBerKG/HKaG (professional jurisdiction), § 203 StGB, HWG, GOÄ, SGB V (in particular § 95d continuing education), BÄO as well as commentary (Ratzel/Lippert/Prütting on the MBO-Ä, Spickhoff Medizinrecht) and BVerfG/BGH case law on healthcare professional advertising. Drafter reviews the professional duty, breach of duty, fault and scope for sanctions in the expert-opinion style. Reviewer checks in particular that the specific LBO (not only MBO-Ä) is cited and that interfaces with § 203 StGB and HWG are identified.

Procedure

1. Applicability of the State Professional Code

Most important methodological switch: the MBO-Ä is only a model; normatively binding is the respective State Professional Code (LBO), which is enacted by the representatives' assembly of the State Medical Chamber on the basis of the state-law Professional Chambers Act (HeilBerKG; in Bavaria: HKaG / Bavarian LBO; KammerG in other states). Before any professional-law assessment, the relevant federal state must be identified and the LBO there included. The LBO may deviate from the MBO-Ä (in particular regarding advertising and remote treatment – federal states have transposed § 7 IV MBO-Ä differently).

2. Advertising § 27 MBO-Ä (in the respective LBO)

§ 27 MBO-Ä permits factually appropriate information, prohibits advertising contrary to professional standards. In particular, the following is contrary to professional standards:

promotional advertising (promises of healing, "100 % success")
misleading advertising (incorrect qualification, false statistics)
comparative advertising in a disparaging form

Constitutional framework: BVerfG line on advertising by healthcare professionals – the formerly strict ban on advertising has been relaxed; the standard is Art. 12 GG. Bans on advertising that categorically prohibit beyond factual information are unconstitutional (BVerfG line since the 1980s; cf. BVerfG, order of 18.10.2001 – 1 BvR 881/00 (https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BVerfG&Datum=18.10.2001&Aktenzeichen=1+BvR+881/00)).

Interface: HWG (Heilmittelwerbegesetz – accompanying; § 11 HWG prohibits certain forms of advertising outside professional circles.

Rating portals: BGH line "jameda I" (judgment of 23.09.2014 – VI ZR 358/13, https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BGH&Datum=23.09.2014&Aktenzeichen=VI+ZR+358/13) and "jameda II" (judgment of 20.02.2018 – VI ZR 30/17, https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BGH&Datum=20.02.2018&Aktenzeichen=VI+ZR+30/17) – the physician's right to deletion on a non-neutral advertising platform; professionally problematic: purchase of paid premium placements if the impression of editorial independence is created.

3. Duty of confidentiality § 9 MBO-Ä (in the respective LBO) in conjunction with § 203 StGB

Strict under professional law; covers more than § 203 StGB (including non-criminal indiscretions). Breach of duty subject to sanctions twice over:

under criminal law § 203 StGB (imprisonment of up to 1 year / fine)
under professional law sanction through the professional court
possibly civil liability § 823 II BGB in conjunction with § 203 StGB; Art. 82 DSGVO

External service providers (IT, billing, typing office): § 203 III StGB (2017 reform) requires the involvement of "other cooperating persons" through a contractual obligation to secrecy; breach of duties of care in selection/supervision is punishable.

4. Documentation § 10 MBO-Ä in conjunction with § 630f BGB

Duty to record all medically relevant measures without delay. Retention at least 10 years after completion of treatment; for minor patients until adulthood + 10 years; X-rays generally 10 years (§ 85 III StrlSchV). In practice, longer retention is advisable because of § 199 II BGB (30 years).

5. Fee § 12 MBO-Ä in conjunction with GOÄ

Fee agreements with private patients only within the framework of the GOÄ; exceeding the increase rate only by written agreement before provision of the service (§ 2 GOÄ). Contract physicians are additionally subject to the EBM and SGB V §§ 87, 87b.

6. Continuing education obligation § 4 MBO-Ä in conjunction with § 95d SGB V

Contract physicians: proof of continuing education every five years (250 CME points). Violation: reduction of remuneration up to suspension of the authorization.

7. Remote treatment § 7(4) MBO-Ä (in the respective LBO)

Relaxation in 2018: exclusive consultation or treatment via communication media is permitted in accordance with the individual federal state if it is medically justifiable and the required medical diligence is maintained. Duty to inform and advise about the special features of exclusive remote treatment.

8. Scope of sanctions

Professional jurisdiction under the respective state HeilBerKG / HKaG. Typical sanctions in ascending order:

Reprimand / warning by the chamber (below the threshold of the professional court)
Censure
Fine (in most LBOs up to € 50,000–100,000, depending on the federal state)
Loss of the passive right to choose a profession in the chamber
Finding of professional unworthiness → Revocation of licensure under § 5 BÄO (licensing authority, not professional court)

Parallel proceedings possible (e.g. criminal proceedings under § 203 StGB + professional court + withdrawal of licensure under § 5 BÄO).

Sources and citation style

Binding: ../../../references/zitierweise.md.

Statute / professional law

MBO-Ä (status of the respective resolution of the German Medical Association; model only) – §§ 2, 4, 7, 8, 9, 10, 12, 27
State professional code of the federal state concerned (binding) – linked via the State Medical Association
HeilBerKG / HKaG / KammerG of the federal state concerned (professional jurisdiction, sanctions)
BÄO – §§ 2 et seq. (licensure), § 5 (revocation), § 6 (suspension)
§ 203 StGB
HWG
GOÄ
§ 95d SGB V (continuing education obligation of contract physicians)
§ 630f BGB (documentation)

Commentaries

Ratzel/Lippert/Prütting, Kommentar zur Musterberufsordnung für Ärzte (MBO-Ä), 7th ed. 2018
Spickhoff, in: Spickhoff, Medizinrecht, 4th ed. 2022, MBO-Ä and HeilBerKG explanations
Laufs/Katzenmeier/Lipp, Handbuch des Arztrechts, 8th ed. 2021, Ch. III (professional law)
Fischer, StGB commentary, current edition, § 203
Cierniak/Niehaus, in: MüKoStGB, current edition, § 203

Case law

BVerfG, order of 18.10.2001 – 1 BvR 881/00 (advertising by healthcare professionals, Art. 12 GG) (https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BVerfG&Datum=18.10.2001&Aktenzeichen=1+BvR+881/00)
BGH, judgment of 23.09.2014 – VI ZR 358/13 (“jameda I”, right to deletion against a rating portal) (https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BGH&Datum=23.09.2014&Aktenzeichen=VI+ZR+358/13)
BGH, judgment of 20.02.2018 – VI ZR 30/17 (“jameda II”, lost neutrality in premium placements) (https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=BGH&Datum=20.02.2018&Aktenzeichen=VI+ZR+30/17)
BVerwG case law on revocation of licensure under § 5 BÄO in cases of professional unworthiness [unverifiziert – prüfen in juris]
State professional court case law on fee agreements beyond GOÄ [unverifiziert – prüfen in juris]

Output format

GUTACHTEN — Berufsrechtliche Prüfung
Mandat:  <anonymisiert>
Bundesland / LBO: <…>
Berufsbezeichnung: <Facharzt für …>

I.   Sachverhalt (knapp)
II.  Frage(n)
III. Kurzantwort
     – Berufspflichtverstoß: [ja / nein / teilweise]
     – Sanktionsrisiko: 🟢 / 🟡 / 🔴

IV.  Rechtliche Bewertung
     1. Einschlägige Berufspflicht
        – LBO § ... (im Bundesland xy)
        – ggf. § ... MBO-Ä als Auslegungshilfe
     2. Pflichtverletzung
        – Tatsachenkern
        – Subsumtion
     3. Schnittstelle § 203 StGB / HWG / GOÄ / SGB V
     4. Verschulden
     5. Sanktionsspielraum (HeilBerKG/HKaG des Landes)
     6. Approbationsfolge § 5 BÄO bei Berufsunwürdigkeit?

V.   Empfehlung
     – Reaktion auf Schreiben der LandesÄK
     – Verteidigungslinie vor Berufsgericht
     – ggf. parallele strafrechtliche Vorsorge

VI.  Risiken / offene Punkte
     🟢 / 🟡 / 🔴

VII. Quellenverzeichnis

Risks / typical mistakes

Citing the MBO-Ä as binding law – MBO-Ä is only a model, only the LBO is binding; MBO-Ä is an interpretive aid.
Before-and-after photos without documented consent of the patients – violation of § 11(1) no. 5 HWG and § 9 MBO-Ä; challengeable under professional law and competition law.
Overlooking the criminal risk under § 203 StGB in parallel with the professional-law sanction.
Blanket advertising ban – overlooking the BVerfG line on Art. 12 GG; factual information is protected.
External IT service providers without an obligation compliant with § 203 III StGB in practice.
Fee agreement with private patients orally or without justification for an increase – violates § 2 GOÄ.
Failure to recognize that withdrawal of licensure under § 5 BÄO is a separate administrative-law proceeding of the district government / state authority – not of the professional court.
Forgot continuing education certificate pursuant to § 95d SGB V – creeping fee reduction up to suspension of authorization.