In a tri-party contract, the question always arises as to who carries out which supply in return for consideration to whom. The main issue here is the requirement of a direct link. A recent German Federal Fiscal Court judgment, which deals with a clinic director’s waiver of his right to perform and invoice for medical treatment, also provides generally applicable statements in this regard. In addition, the German Federal Fiscal Court concretises its jurisprudence on the conditions under which an actus contrarius to a supply can be VAT exempt in the same way as the supply itself.