On October 15, 2025, the French Cour de cassation (“Court”) confirmed a €680,000 fine on the trade union Les Chirurgiens-Dentistes de France (“CDF”) (“Decision”).[1] The Court held that the CDF’s call for a boycott of certain dental care networks constituted a restriction of competition by object within the meaning of Article 101 TFEU and Article L. 420-1 of the French Commercial Code.[2]
This case highlights that professional organizations, including trade unions, are not exempt from competition law, and claims that they acted in the public interest will be carefully scrutinized.
Background
In France, dental care networks are set up through agreements entered into between complementary health insurers (“organismes complémentaires d’assurance maladie” or “OCAM”) and dentists. These networks provide recommendations to patients on treatments, implement third-party payment systems, and cap and monitor treatment costs, at levels that are typically lower than those of non-affiliated dentists.[3]
The Ordre National des Chirurgiens-Dentistes (“Order”) regulates access to the dental profession and oversees compliance with professional rules. Trade unions and federations, such as the Fédération des Syndicats Dentaires Libéraux (“FSDL”) and the CDF, negotiate with the national healthcare system, notably on rates and treatments.[4] At the time of the case, the CDF represented around one-third of French self-employed dentists.[5]
According to the evidence cited by the Decision, the Order, FSDL and CDF feared non-affiliated dentists were unable to match dental care networks’ lower fees and active patient solicitation[6] and that such networks jeopardized the quality and diversity of treatments available to patients and, as a result, patients’ freedom of choice, as well as the dental profession’s independence.[7]
Following a complaint filed in 2014 by the dental care network Santéclair, the FCA carried out dawn raids at the premises of the Order’s national council and certain departmental councils, the FSDL, and the dental practice of the FSDL’s president. In 2020, the FCA found that the CDF, alongside the Order and FSDL, had coordinated actions to boycott certain networks, discourage patients from using network-affiliated dentists, and pressure insurers to delay new networks, constituting a restriction of competition by object within the meaning of Article 101 TFEU and Article L. 420-1 of the French Commercial Code for which the parties were fined a total of €4,000,000.
The FCA found this conduct to be particularly serious, as it was carried out by professional bodies responsible for compliance and the sector’s two main unions,[8] and hindered the development of networks designed to improve access to affordable care by reducing patients’ out-of-pocket expenses.[9] The FCA held that the practices reduced patients’ freedom of choice[10] by limiting their access to a variety of cheaper network-affiliated dentists in a sector already marked by high treatment costs[11] and inherent low switching (as patients tend to remain with their current dentist).[12] The severity of the infringement was further compounded by the Order’s prior sanctions for similar conduct in 2005, 2009, and 2014, meaning all parties were aware of the associated competition law risks.[13]
On December 17, 2020, the Order, the FSDL, and the CDF lodged an appeal against the FCA’s Decision. The Paris Court of Appeals dismissed the appeal on September 14, 2023,[14] finding in particular that the CDF’s conduct exceeded legitimate trade union advocacy and that it encouraged members to adopt a common market position, thereby constituting a restriction of competition by object.[15] Highlighting that the networks targeted by the CDF were lawfully established and regulated,[16] the Court of Appeals rejected the CDF’s claim that it was merely acting in defense of the dental profession, pursuant to its mandate and in response to its members’ complaints against Santéclair,[17] finding instead that the CDF’s conduct stemmed from a broader opposition to networks formed without union involvement.[18] Following this dismissal, the CDF lodged an appeal with the French Cour de cassation.
Ruling of the French Cour de cassation
The key legal issue brought before the French Cour de cassation was whether a professional organization may invoke freedom of association and expression to avoid the characterization of anticompetitive agreement when calling for a boycott of economic operators. In support of its appeal, the CDF argued that its actions merely reflected the exercise of these fundamental freedoms and pursued the defense of patients’ interests, therefore serving a legitimate public-interest objective.[19]
The Court first recalled that a professional organization constitutes an association of undertakings under Article 101 TFEU when it seeks to secure from its members a particular course of conduct in the exercise of their economic activity.[20] In this context, the Court emphasized that the pursuit of public-interest objectives cannot justify conduct that, “far from merely having the inherent effect of potentially restricting competition by limiting the freedom of certain undertakings, exhibits a degree of harm to competition sufficient to consider that its very object is to prevent, restrict, or distort competition.”[21] The Court also recalled that the freedoms of association and expression are not absolute and may be subject to legal restrictions pursuing legitimate and necessary objectives in a democratic society, including the enforcement of competition law.[22] On this basis, the Court dismissed the CDF’s claims in this regard.
Furthermore, the Court endorsed the Court of Appeals’ analysis of the networks’ legality, recalling that they had been validated both legislatively[23] and constitutionally,[24] and that nothing indicated that the agreements between dentists and the targeted networks breached professional conduct rules.[25] Additionally, the Court noted that the French Conseil d’État had already held that joining dental care networks and, upon request, informing patients of fees charged by network-affiliated dentists did not constitute a breach of professional independence, unlawful advertising, or patient poaching.[26]
Finally, the Court upheld the Court of Appeals’ assessment of the facts, noting that, while the CDF supported network agreements negotiated with dentists unions, it opposed arrangements – such as Santéclair’s – concluded directly between insurers and dentists without union involvement. The Court further observed that complaints from dentists about patient poaching by dental care networks did not justify anticompetitive conduct, and that no evidence existed of any such systematic patient poaching.[27]
In light of the above, the Court confirmed the Court of Appeals’ finding that the CDF’s conduct constituted a restriction of competition by object.[28]
Key takeaways
This Ruling reaffirms the applicability of competition law to trade union and professional-body activity. The French Cour de cassation made clear that professional bodies are not exempt from the scope of Article 101 TFEU when they seek to influence the market behavior of their members. The Ruling also confirmed that reliance on public-interest objectives cannot justify collective actions – such as calls for a boycott – that amount to a restriction of competition by object.
[1] FCA, November 12, 2020, decision no. 20-D-17 (“Decision”), available here. The CDF was formerly known as the Confédération nationale des syndicats dentaires (“CNSD”).
[2] French Cour de cassation, Commercial Chamber, October 15, 2025, no. 23-21.370 ( “Ruling”), available here.
[3] Decision, para. 42.
[4] As set out in article L.162-9 of the French Social Security Code. See for example the 2023-2028 National Convention of Dental Surgeons negotiated by the CDF and the FSDL, available here.
[5] Decision, para. 92.
[6] Ibid., see for example paras. 208, 288 and 389.
[7] Ibid., see for example para. 48.
[8] Ibid., paras. 834, 885.
[9] Ibid., para. 835, 885.
[10] Ibid., paras. 852.
[11] Ibid., para. 42.
[12] Ibid, para. 852.
[13] Ibid., paras. 876-880.
[14] Paris Court of Appeals, Commercial Chamber, September 14, 2023, no. 20/17860, available here.
[15] Ibid., para. 334-335.
[16] Ibid., para. 335.
[17] Ibid., para. 328.
[18] Ibid., para. 307.
[19] Ibid., para. 6.
[20] Ibid., para. 7, citing the European Court of Justice’s ruling of February 19, 2002, Wouters et al. (C‑309/99), para. 64.
[21] Ruling, para. 8. Free translation.
[22] Ibid., paras. 9-10, citing articles 10(2) and 11(2) of the European Convention on Human Rights.
[23] French Law no. 2014-57 of January 27, 2014.
[24] French Constitutional Council, January 23, 2014, no. 2013-686 DC.
[25] Ruling, para. 14.
[26] Ibid., paras. 15-16, citing the French Conseil d’État’s ruling no. 189657 of May 4, 2000.
[27] Ibid., para. 17.
[28] Ibid., para. 18.