Supreme Court: IRAP should not be passed on to the doctor but to the user with an appropriate fee.

The cost incurred by the Health Authority for IRAP cannot be passed on to the physician performing in-house professional activity, through a substantial reduction in his or her compensation, but must be passed on to the users, through an appropriate fee. Otherwise, the tax burden would end up falling on someone other than the one carrying out the productive activity.

Article 2 of Legislative Decree No. 446 of 15 December 1997 (Establishment of the Regional Tax on Productive Activities - IRAP) aligns this view, stating that "the basis for the tax is the habitual exercise of an independently organized activity aimed at the production or exchange of goods or the provision of services. The activity carried out by companies and entities, including state bodies and administrations, constitutes a basis for the tax in any case."

In these terms, the Court of Cassation (order no. 9655 of 2025) rejected the appeal against the ruling by which the Palermo Court of Appeal had ordered the Palermo Provincial Health Authority to return to a medical director the sums withheld as IRAP for activities carried out under the intramoenia regime.

The Supreme Court ruled that "IRAP is a burden on the healthcare company and not on the employee who provides the service." This decision confirms the established case law according to which:

- «the tax cannot be passed on, in the sense that the health company cannot claim to place it exclusively on the employee [and] deduct it from the compensation due to the latter» (Cassation, ruling of 21 June 2022, no. 20010; see Cassation, order of 8 January 2020, no. 155);