Transactions relating to payments or transfers of money are specifically exempted from VAT by the Principal VAT Directive. The questions in this case were whether DPAS supplied services to patients and, if so, whether they were exempt from VAT under this particular heading.
The CJEU issued a judgment in 2010 in a similar case (Axa Denplan) which ruled that the services were not exempt transactions but were, instead, debt collection services which were subject to VAT.
DPAS' response to Axa Denplan was to alter its business model to ensure that its services were supplied to the patients and could not, therefore be regarded as debt collection.