Health care provision in kind through intermediary agency

A BIG-accredited registered nurse (BIG being the Dutch Register of Health Care Professionals) through an intermediary agency was providing health care services in kind, under the General Law on Exceptional Medical Expenses, to a number of residential care agencies in 2012 and 2013. Having originally furnished the nurse with a Declaration of Income Tax Status (profits from business activities), the Tax and Customs Administration went on to replace said Declaration with a Declaration of Income Tax Status (income from employment). At stake was the question whether the nurse’s activities as a care giver should be regarded as business operations or as duties performed in employment.

According to the District Court the nurse did not qualify as a sole trader, as she neither formed part of such care institutions as were authorised on the instructions of a care agency to provide a care recipient with health care services in kind in the context of the General Law on Exceptional Medical Expenses nor provided such services in kind by virtue of her being under contract with a care agency, in addition to which she did not on her own conclude agreements with care recipients either. There was no question of her being an independent operator where her association with the care provider was concerned. According to the Court, the nurse lacked entitlement to a Declaration of Income Tax Status (profits from business activities) whereas her employment relationship did comply with the criteria governing private-law employment, so that the Tax and Customs Administration had been acting appropriately when it issued a Declaration with a Declaration of Income Tax Status (income from employment) for 2012 and 2013.