업무정지처분취소
1. All of the plaintiff's claims are dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
Details of the disposition
A. The Plaintiff is an oriental medical doctor who establishes and operates a “BDwon” in the Ganbuk-gu Nutrition Group (hereinafter “instant oriental medical doctor”).
B. Around May 2017, the Defendant conducted an on-site investigation on the current status, etc. of the claim for medical care benefit costs from June 2016 to August 2016, and from January 2017 to March 2017 (six months from the date of investigation).
(hereinafter “instant on-site investigation”). C.
Based on the results of the instant on-site investigation, on April 23, 2019, the Defendant: (a) imposed an insurer, etc. totaling KRW 19,071,510 on the grounds that the Plaintiff violated the National Health Insurance Act by deceit or other fraudulent means in violation of the National Health Insurance Act; and (b) rendered a disposition of business suspension of 93 days on the basis of Article 98(1)1 of the former National Health Insurance Act (amended by Act No. 14776, Apr. 18, 2017; hereinafter “former National Health Insurance Act”).
On April 15, 2019, the Defendant issued a disposition of business suspension of 67 days of medical care institutions based on Article 28(1)1 of the former Medical Care Assistance Act (amended by Act No. 16253, Jan. 15, 2019; hereinafter “former Medical Care Assistance Act”) on the ground that the Plaintiff imposed medical care costs of KRW 2,232,140 on a beneficiary, etc. on the same ground.
(hereinafter “instant disposition”). Grounds for the instant disposition
1. Suspension of medical care institutions;
(a) Unfair amount: 19,071,510 won;
(b) Improper Claim for Medicines - In the case of a certain number of winners, the medical care benefit cost claim is claimed as a result of making a mixture of d and E, which is a benefit medicine preparation, even though it has been administered by prescribing C, which is a non-benefit medicine preparation.
(c) Calculation details of administrative disposition (unit: source, percentage, day, hereinafter the same shall apply) and the total amount of costs of health care benefit (from June 2016 to January 8, 2016, from January 2017 to June 2017, 124,404, 800 19,071, 510 3, 178, 585.393.393
2. Suspension of business;
(a) Unfair amount: 2,232,140 won;
(b)medical instruments - medical care institutions.