What is the significance of the medical officer's certificate?

It is difficult for tax officials to assess whether expenses are for the treatment or alleviation of an illness and thus 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 companies, clearly stating the illness and 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 companies 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 spa treatment, the risk of an illness to be averted by the treatment must also be certified, in the case of a climate spa treatment, the medically indicated spa location and the expected duration of the treatment must be certified,
• psychotherapeutic treatment,
• medically necessary accommodation away from home for a child of the taxpayer suffering from dyslexia or another disability,
• necessity of care for the taxpayer by an accompanying person, 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 anthroposophy under statutory health insurance law (BFH ruling of 26.2.2014, VI R 27/13).

The Federal Fiscal Court recently ruled that the costs for liposuction to treat lipoedema are tax-deductible. From 2016, these expenses can usually be considered as extraordinary expenses without the need for a public health officer's report or a medical certificate from the Medical Service of the health insurance company issued before the operation (BFH ruling of 23.3.2023, VI R 39/20).