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(영문) 서울행정법원 2019.09.26 2018구합89282

요양급여비용 환수결정처분 취소

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. The Plaintiff established and operated “C”, a long-term care institution, in Gangnam-si B (hereinafter “instant facilities”), and provided beneficiaries with facility benefits.

1. Amount of unfair claims: 69,576,150 won;

2. On May 16, 2016, from May 16, 2016 to May 31, 2016, the details of the violation of the standards for placement of human resources: (a) the Plaintiff sent the caregiver to another long-term care institution (hereinafter “E”) operated by the Plaintiff; (b) the caregiverF registered the work hours of caregiver as if he/she worked in the instant facility during the said period; and (c) even if he/she was placed exclusively as a cook during the period from November 1, 2015 to September 30, 2016 and actually performed the work at the kitchen, he/she registered the work hours as if he/she was working as a caregiver; and accordingly, the head of the relevant facility G registered the work hours as if he/she was working as a caregiver; and (d) the period during which he/she violated the standards for placement of human resources for caregivers, and claimed for reimbursement without reducing the expenses for benefits on August 2016 (hereinafter “instant ground for disposition”).

(2) Although the need for additional placement of human resources is not applicable due to the following facts, the cost of benefits was paid by applying the additional placement of human resources and the additional placement of necessary human resources during the period from March 2016 to June 2017, 2017; and (a) the period from August 1, 2015 to September 30, 2016; and (b) the “F,” who reported as a caregiver, actually worked as a caregiver at the kitchen and was in violation of the standards for placement of human resources; (b) the SP, as the relative of the head of the facility G, while residing in the three-story staff of the instant facility; and (c) the laundry and the daily laundry from October 4, 2016 to the laundry from October 30, 2017 to the laundry; and (d) the laundry and the laundry from the laundry to the laundry.