Tag Archives: healthcare

VAT: Doctors and healthcare professionals

By Marcus Ward 29 January 2018

VAT and Doctors

I have noticed that I am receiving more and more queries in this area and HMRC does appear to be taking an increased interest in healthcare entities. This is hardly surprising as it can be complex and there are some big numbers involved.

(This article refers to doctors, but applies equally to most healthcare professional entities.)

The majority of the services provided by doctors’ practices are VAT free. Good news one would think; no need to charge VAT and no need to deal with VAT records, returns and inspections.

However, there is one often repeated question from practices; “How can we reclaim the VAT we are charged?”

The first point to make is that if a practice only makes exempt supplies (of medical services) it is not permitted to register for VAT and consequently cannot recover any input tax. Therefore we must look at the types of supplies that a practice may make that are taxable (at the standard or zero rate). If any of these supplies are made it is possible to VAT register regardless of the value of them. Of course, if taxable supplies are made, the value of which exceeds the current turnover limit of £85,000 in a rolling 12-month period, registration is mandatory.

Examples of services and goods which may be taxable are:

Drugs, medicines or appliances that are dispensed by doctors to patients for self-administration
Dispensing drugs against an NHS prescription (zero-rated)
Drugs dispensed against private prescriptions (standard-rated)
Medico legal services that are predominately legal rather than medical – for example negotiating on behalf of a client or appearing in court in the capacity of an advocate
Clinical trials or market research services for drug companies that do not involve the care or assessment of a patient
Paternity testing
Certain rental of rooms/spaces
Car parking
Signing passport applications
Providing professional witness evidence
Any services which are not in respect of; the protection, maintenance or restoration of health of a patient.

So what does VAT registration mean?

Once you join the “VAT Club” you will be required to file a VAT return on a monthly of quarterly basis. You may have to issue certain documentation to patients/organisations to whom you make VATable supplies. You may need to charge VAT at 20% on some services. You will be able to reclaim VAT charged to you on purchases and other expenditure subject to partial exemption rules (see below). You will have to keep records in a certain way and your accounting system needs to be able to process specific information.

Because doctors usually provide services which attract varying VAT treatment, a practice will be required to attribute VAT incurred on expenditure (input tax) to each of these categories. Generally speaking, only VAT incurred in respect of zero-rated and standard-rated services may be recovered. In addition, there will always be input tax which is not attributable to any specific service and is “overhead” eg; property costs, professional fees, telephones etc. There is a set way in which the recoverable portion of this VAT is calculated. VAT registered entities which make both taxable and exempt supplies are deemed “partly exempt” and must carry out calculations on every VAT return.

Partial Exemption

Once the calculations described above have been carried out, the resultant amount of input tax which relates to exempt supplies is compared to the de-minimis limits (broadly; £625 per month VAT and not more than 50% of all input tax). If the figure is below these limits, all VAT incurred is recoverable regardless of what activities the practice is involved in.

VAT registration in summary

Benefits

Recovery of input tax; the cost of which is not claimable in any other way
Potentially, recovery of VAT on items such as property, refurbishment and other expenditure that would have been unavailable prior to VAT registration
Only a small amount of VAT is likely to be chargeable by a practice
May provide opportunities for pre-registration VAT claims

Drawbacks

Increased administration, paperwork and staff time
Exposure to VAT penalties and interest
May require VAT to be added to some services provided which were hitherto VAT free
Likely that only an element of input tax is recoverable as a result of partial exemption
Uncertainty on the VAT position of certain services due to current EU cases
Potential increased costs to the practice in respect of professional fees.

Please contact us if any of the above affects you or your clients.

VAT – Extent of healthcare exemption. Latest from the courts

By Marcus Ward 26 June 2017

In the First Tier Tribunal (FTT) the case of The Learning Centre (Romford) Ltd (TLC) the exemption for healthcare was considered.

Background

The appellant provides day-care to vulnerable adults with learning difficulties (referred to as students). Both directors have relevant qualifications and a great deal of experience in providing the care which the company provides. The taxpayer provided their students with education, activities, and entertainment during working hours Monday to Friday, providing meals and, where required, assistance with eating, administering medication, and personal care. They also provided the transport to bring the students to and from their homes and the facility. The education provided was geared towards teaching the students independent living.

While HMRC accepted that what the appellant provided was ‘welfare services’ within the meaning of the Value Added Tax Act 1994, Schedule 9, Group 7 Item 9 and Note (6), exemption applied only where it was supplied by a specified type of entity. Those entities are:

1) A charity

2) A state-regulated private welfare institution or agency, or

3) A public body.

The appellant was not a charity: it was a company which ran the business for profit. As a privately owned company, it was not a public body either. The only possible category for the appellant was ‘a state-regulated private welfare institution or agency’ and HMRC did not accept that the appellant fell within that category. Day-care is not regulated in England and as a consequence HMRC decided it is not covered by the exemption.

Decision

The FTT found for the appellant. It was noted that day-care is regulated in Scotland and it would be a breach of fiscal neutrality if the VAT treatment of day-care was different North and South of the border. TLC could rely on the direct effect of the Principal VAT Directive and, as a consequence, could treat its supplies as exempt and deregister from VAT.

Commentary

It was a logical decision, however, logic does not always play a part in VAT…. It sought to level a playing field that was far from that. If the decision had been in favour of HMRC the VAT treatment would have been different if the supply had been made:

in other areas of the UK
by the Local Authority
by a charity

contrary to EC law.

There are many businesses which provide similar services and it is imperative that they review their VAT position immediately. We can assist with this.

VAT Latest from the courts – more on composite or separate supplies

By Marcus Ward 1 August 2016

The case of: General Healthcare Group Limited (GHG)

Those that have read my articles in the past will recognise the topic of composite or separate supplies rears its ugly head on many occasions. It is a matter that has occupied businesses, advisers and HMRC since VAT’s inception, and shows no signs of disappearing any time soon. To put it into the Tribunal chairman’s words: This is another appeal on the subject of whether a transaction which comprises several different elements should be regarded as a single supply or several distinct and independent supplies.

In the latest episode, a ruling was handed down by the Upper Tribunal (UTT) in the case of GHG.

Background

GHG challenged the decision in the First tier Tribunal (FTT) that it made a single supply of prostheses and operating services via its consultants. Consultants fit prostheses in certain procedures, eg; hip replacements when they operate in GHG hospitals. The prostheses are supplied by GHG which also provide the hospital facilities to enable the independent, self-employed consultants to supply healthcare which includes the fitting of prostheses, to its patients. The FTT (in the lead case of Nuffield Hospital with GHG) decided that there was a single supply of exempt healthcare to the patient in these circumstances. GHG appealed against this decision, contending that there is one supply of exempt healthcare, and a separate zero rated supply of the prosthetics prescribed and fitted by the consultants who performed the operations.

VAT Impact

Treating the prosthetics as zero rated rather than exempt would have no impact on output tax (no VAT would be due in either analysis) but zero rating would enable GHG to recover input tax on the prosthetics in question and an increased amount of VAT incurred on general overheads. It is likely that such a claim, across the board would run into many multi-millions.

Decision

The UT dismissed GHG’s appeal, stating that “… from the point of view of the typical patient who requires a prosthesis, GHG makes a single supply of hospital and medical care which includes providing the prosthesis to be fitted by the consultant …”.

Commentary

The decision appears logical and in line with both EC and UK legislation and past case law and was not really a surprise. In these type of cases it is important to consider what the recipient of the supply thinks (s)he is receiving. In this case, and having been on the receiving end of a similar procedure (although I hope that I am a few years off a hip replacement) I think it is absolutely accurate to say that the patient would consider that (s)he is receiving a single supply of medical care. However, I have no doubt that the patient who has just received a new hip would be very unlikely to be thinking of the VAT treatment of their….errr treatment in the slightest…..

The UTT chairman stated that it declined to make any reference to the CJEU.

As always, this is a tricky area, if you have received any questionable rulings from HMRC on single/multiple supplies, or wonder whether there is a different way of analysing your supplies, please contact us as explained above, the matter continues to throw up interesting results.

Full case here