장기요양기관업무정지처분취소
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 operating a “movable and Welfare Village”, a long-term care institution under the Act on Long-Term Care Insurance for the Aged (hereinafter “instant medical care institution”).
Calculation Criteria: 9,395,70 won - Medical care workers A, April 2013 or
5. Although he/she did not work as a caregiver and violated the criteria for placement of human resources during the pertinent period, he/she files a false claim different from the rate for calculation of expenses for benefits during the said period. In cases of physical therapy B, he/she shall file a report on working hours differently from the fact that he/she worked as a caregiver (at least 160 hours a month) from August 201 to November 201, 2012 (at least 160 hours a month), and the Sanitation Board C on April 2013 to April 2013.
5. On November 2013 to December 12, 2013, the Sanitary Board A did not actually work for the above period, and even though it violated the criteria for placement of human resources due to a failure to work for the above period, it claimed that the rate of calculation of expenses for benefits is different from the rate of calculation of expenses for benefits on November 2012, 2012 to November 2014. False Claim: 308,630 recipients D et al. of KRW 308,630 and 5 other than the beneficiaries D et al. of KRW al. who did not provide the service due to gambling.
As a result of conducting a field investigation on the details of benefits from August 24, 2012 to December 27, 2014 by the instant medical care institution from February 24, 2015 to March 27, 2015, it was confirmed that the Plaintiff unfairly received expenses for long-term care benefits amounting to KRW 159,663,840 in total (hereinafter “instant violation”).
C. As a result of the above on-site investigation, the National Health Insurance Corporation rendered a disposition to recover KRW 159,663,840 of the cost of long-term care benefits received by the Plaintiff pursuant to Article 43 of the Act on Long-Term Care Insurance for the Aged, and the said disposition was finalized around that time.
On March 3, 2016, the Defendant rendered a disposition of 91 days of business suspension (from April 1, 2016 to June 30, 2016) pursuant to Article 37(1)4 of the Long-Term Care Insurance Act and Article 29 [Attachment II] of the Enforcement Rule of the same Act to the Plaintiff on the ground of the instant violation.