장기요양급여비용 환수처분 취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. Details of the disposition;
A. The Plaintiff is a person running C (hereinafter “instant facilities”) who is a long-term care institution under the Act on Long-Term Care Insurance for the Aged in Echeon-si (hereinafter “Act”).
The defendant is an insurer of the long-term care insurance program under the control of the Minister of Health and Welfare who manages the program.
B. On January 15, 2018 through January 19, 2018, the Defendant conducted an on-site investigation of the instant facility, and thereafter, on July 25, 2018, notified the Plaintiff of a decision that the expenses for long-term care benefits already paid to the Plaintiff should be recovered KRW 19,837,980, but the Defendant should be offset and subtracted when paying the following expenses for long-term care benefits.
(2) On-the-spot investigation (hereinafter referred to as “on-site investigation”) and the decision of recovery (hereinafter referred to as “the instant disposition”). The details and reasons for the restitution are as follows:
C. The specific reasons for the restitution details are as follows:
1) The recipient and the Plaintiff who failed to report the omission of the recipients in violation of the criteria for placement of human resources should calculate the relevant monthly expenses for the period in violation of the criteria for placement of human resources under Article 23 of the Enforcement Rule of the Act according to the proportion of human resources vacancies. However, as follows, the recipient or the person outside the class omitted the relevant monthly expenses for the period in violation of the criteria for placement of human resources.
① In relation to D, during the pertinent period in April 2015, the recipient was omitted from the current status by falsely reporting the actual admission date to D during the pertinent period from January 2015 to April 2015. < Amended by Presidential Decree No. 20200, Feb. 2017> (3) In relation to D, the recipient was omitted from the current status by falsely reporting the actual admission date during the pertinent period from January 2015 to April 2017.