(2023)
What is the significance of the official medical certificate?
It is difficult for tax officials to assess whether expenses are for the treatment or alleviation of an illness and are therefore tax-deductible, or whether they are for general prevention and health maintenance and therefore cannot be deducted for tax purposes.
In any case, tax officials do not have the expertise to objectively assess the medical indication. Therefore, in certain cases, they require a certificate from the public health officer or the Medical Service of the Health Insurance Funds, clearly stating the illness and the medical indication. This certificate must be obtained before the start of treatment. Many honest citizens have failed at these two hurdles and have been left with often high medical costs.
The cases in which a certificate from the public health officer or the Medical Service of the Health Insurance Funds must be obtained and submitted to the tax office are explicitly stated in the law (§ 64 para. 1 no. 2 EStDV):
- Bath or spa treatment; in the case of a preventive cure, the risk of an illness to be averted by the cure must also be certified, in the case of a climate cure, the medically indicated spa location and the expected duration of the cure must be certified,
- psychotherapeutic treatment,
- medically necessary accommodation away from home for a child of the taxpayer suffering from dyslexia or another disability,
- necessity for the taxpayer to be accompanied by a carer, unless this is already evident from the severely disabled person's pass,
- medical aids considered to be general everyday items,
- scientifically unrecognised treatment methods, such as fresh and dry cell treatments, oxygen, chelation, and autologous blood therapy.
In other cases, the tax office must accept the submitted costs and may not require a public health officer's certificate. For example, expenses for curative eurythmy treatments are deductible as extraordinary expenses in accordance with § 33 EStG. It is not necessary to submit a public health officer's certificate; a prescription from the GP is sufficient. Curative eurythmy is not a scientifically unrecognised method but is recognised as a special therapy within the framework of anthroposophy in the law of statutory health insurance (BFH ruling of 26.2.2014, VI R 27/13).
The Federal Fiscal Court recently ruled that the costs of liposuction for the treatment of lipoedema are tax-deductible. From 2016, these expenses can generally be considered as extraordinary expenses without the need for an expert opinion from the public health officer or a medical certificate from the Medical Service of the Health Insurance Fund issued before the operation (BFH ruling of 23.3.2023, VI R 39/20).
