Jurisdiction in disputes between Local Health Authorities (ASL) and healthcare facilities: a focus on Order no. 29613 of 2025

The allocation of jurisdiction between ordinary courts and administrative courts has always represented one of the most complex and debated issues in Italian public and civil law. Recently, the Joint Chambers of the Court of Cassation intervened with the significant Order no. 29613 of November 10, 2025, to clarify a crucial aspect of the National Health Service: the action for recovery of undue payment (ripetizione dell'indebito) brought by an ASL against a private healthcare facility lacking accreditation requirements.

The case and the decision of the Joint Chambers

The matter originates from a dispute involving the parties A. L. D. and S. T. and concerns healthcare services provided under an accreditation regime. The ASL had requested the restitution of sums paid as a co-payment for healthcare expenses, challenging the facility's lack of the requirements provided for by regional legislation to operate under an accreditation regime. The Court of Appeal of Lecce had previously ruled on the matter, but the case reached the Supreme Court to definitively resolve the issue related to jurisdiction.

The distinction between the public law phase and the contractual phase

To understand the decision of the judges of legitimacy, it is necessary to distinguish two fundamental stages in the relationship between the Public Administration (in this case, the ASL) and private healthcare facilities:

• The public law phase, which concerns the accreditation grant provision and the verification of institutional requirements, falling under the jurisdiction of the administrative court.
• The contractual phase, which pertains to the execution of the economic relationship and the actual provision of services, governed by private law and devolved to the jurisdiction of the ordinary court.

In the present case, the ASL's action did not aim to challenge an administrative provision or the exercise of discretionary power, but rather to recover sums unduly paid to a facility not entitled to receive them.

The principle of law of the Court of Cassation

The Joint Chambers have crystallized this orientation within the following principle of law, which unequivocally defines the boundaries of ordinary jurisdiction:

Regarding healthcare services provided under an accreditation regime, the claim for recovery of undue payment brought by the ASL against the healthcare facility, due to the lack of accreditation requirements, falls under the jurisdiction of the ordinary court, as it is based on the verification of the non-existence of the obligation to contribute to the expense, which pertains to the contractual phase of the relationship.

This principle highlights how the ASL's restitution claim is based on a mere breach of contract or the absence of a valid title for payment (objective undue payment pursuant to art. 2033 of the Italian Civil Code). The exercise of authoritative powers by the Public Administration is not at issue, but rather a give-and-take relationship of a purely private nature.

Conclusions and practical implications

In conclusion, Order no. 29613 of 2025 reaffirms a principle of fundamental importance for legal certainty and the protection of public resources. When the ASL acts to recover sums unduly disbursed due to the lack of accreditation requirements of the facility, the action must be brought before the ordinary Civil Court. This decision facilitates the linearity of legal protections and prevents unnecessary jurisdictional conflicts, ensuring a faster resolution of economic disputes in the healthcare sector.