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(영문) 인천지방법원 2017.02.09 2015구합53125

장기요양급여비용 환수결정처분취소

Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. From November 2012, the Plaintiff is operating a long-term care institution for older persons (hereinafter “instant medical care institution”) with a trade name, i.e., “C Older Persons Medical Care Center” (hereinafter “instant medical care institution”).

B. The Defendant conducted an on-site investigation (the period subject to the investigation: November 1, 2012 to December 2014) on the instant medical care institution for four days from January 27, 2015 to January 30, 2015, jointly with the head of the Incheon Southern-dong, for four days.

As a result, even though the instant medical care institution violated the criteria for placement of human resources for working clinics from November 201 to April 2014 (excluding December 2013) and from July 1, 2014 to October 2014, it found the fact that: (a) the instant medical care institution claimed for additional placement of human resources in violation of the criteria for placement of human resources from May 9, 2013 and from January 2014 to October 9, 2014; (b) even though it violated the criteria for additional placement of human resources from May 9, 2013 and January 201 to October 2014, it claimed for additional placement of human resources and claimed for additional placement of human resources from 81,260,210 won; and (c) even though it provided the recipient with the service at undesignated facilities from December 1, 2014 to December 9, 2014.

C. On July 7, 2015, pursuant to Article 43(1) of the former Act on Long-Term Care Insurance for the Aged (amended by Act No. 13647, Dec. 29, 2015; hereinafter “long-term Care Insurance for the Aged”) for the Aged, the Defendant rendered a decision to recover KRW 163,978,240 (hereinafter the “instant disposition”) that the Plaintiff is disputing the Plaintiff among the foregoing restitution decision (hereinafter the “instant restitution decision”).

[Ground of recognition] Unsatisfy, Gap-1's entry and purport of whole pleadings

2. Whether the instant disposition is lawful

A. The Plaintiff’s assertion (1) The Defendant, in violation of the criteria for placement of human resources for a work clinic, recovered the allowance for benefits on the ground that: (a) the Defendant registered that the work clinic D had worked for at least 15 hours from January 2014 to April 2014; and (b) had worked for at least 135 hours from July 115 to October 2014; and (c) claimed the allowance for benefits for at least 160 hours each month.

1. However, in fact.