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(영문) 서울행정법원 2012.11.29 2012구합10383

요양급여비용환수결정취소

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1. The Defendant’s reimbursement disposition of KRW 9,935,950 for the Plaintiff on February 23, 2012, KRW 9,578,420 for the costs of health care benefit.

Reasons

1. Details of the disposition;

A. As a dentist, the Plaintiff established a C dental clinic (hereinafter “instant clinic”) which is a medical care institution in Seocho-gu Seoul Metropolitan Government and performed medical treatment.

B. From January 25, 2010 to January 29, 2010, pursuant to Article 84(2) of the former National Health Insurance Act (amended by Act No. 11141, Dec. 31, 201; hereinafter “former National Health Insurance Act”), the Defendant conducted an on-site investigation on medical care benefits and medical benefits (hereinafter “instant investigation”) for the 13-month period from November 1, 2008 to November 30, 209.

C. The Defendant confirmed whether part of the patients were actually treated in the process of the above investigation, and prepared the list of patients whose contents are inconsistent with the medical records of the instant Council members and the daily business report, and had the Plaintiff confirm it.

The plaintiff alleged that part of the above list is a patient who actually provided medical treatment, and that he did not impose his own charge on his family, relatives, and relatives, etc., and the defendant deleted the list of 17 students and 245 students, from the original list of patients.

On January 29, 2010, the Plaintiff’s husband D and the Plaintiff, who provided the medical treatment together with the Plaintiff, stated that the Plaintiff provided medical treatment to patients not admitted to the hospital, and filed a false claim for medical care benefit costs. The Plaintiff signed and sealed the confirmation document attached to the list of patients claiming medical care benefit costs (hereinafter “instant confirmation document”) and submitted it to the Defendant.

E. On February 23, 2012, the Defendant rendered a disposition to recover KRW 9,935,950 (hereinafter “instant disposition”) by means of false representation against the Plaintiff pursuant to Article 52 of the former National Health Insurance Act.

[Ground of recognition] without any dispute, Gap 1, 2, and Eul 1 to 3 respectively.