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(영문) 서울행정법원 2017.11.02 2017구합52863

장기요양급여비용 환수처분 취소

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On January 13, 2016, the amount of KRW 19,485,330 among the disposition of recovery of expenses for long-term care benefits rendered by the Defendant to the Plaintiff is revoked.

Reasons

1. Details and details of the disposition;

A. The Plaintiff is establishing and operating a long-term care institution in Jeju City B (hereinafter “instant medical care institution”).

B. From December 2012 to July 2015, the Plaintiff sent two caregivers to the recipients C, D, E, F, G, and H (hereinafter “beneficiary C, etc.”) and provided them with bathing services.

The above two caregivers provided the above recipients with visiting bathing service, together with the "preparation for bath, assistance in moving in bathing, taking clothes, and taking bathing after bathing." However, only the "physical cleaning agent" did not meet the above recipients' wishes, and only one caregiver, who is the same as the above recipients, was a single caregiver.

C. Jeju Mayor: (a) conducted on-site investigations with respect to the instant medical care institution during the period of investigation from November 3, 2015 to November 6, 2015, setting the period of investigation from December 12, 2012 to September 2015.

On January 13, 2016, the Defendant notified the Plaintiff of the determination on restitution of the aggregate of KRW 19,872,560 of the expenses for long-term care benefits pursuant to Article 43(1) of the Long-Term Care Insurance Act, on the ground that “the Plaintiff received 19,872,560 won, including the Plaintiff’s provision of visiting bath to the beneficiary C, by unfairly claiming for the provision of 19,485,330 won, even though the Plaintiff provided some processes, such as the same-sex caregiver, and the Plaintiff did not provide other visiting care services, and received the payment of KRW 19,872,560, such as claiming for medical care benefits.”

(A) Of the decision on recovery, the part of KRW 19,485,30, which was filed by two caregivers for the reason that they were provided by the same-sex caregivers even though one of them was provided by the same-sex caregivers in the process of the decision on recovery hereinafter referred to as “the instant disposition”). [In the absence of dispute, Gap’s evidence Nos. 1, 2, 4-12, and Eul’s evidence Nos. 1 and 2, and the purport of the entire pleadings

2. Attached Form 2 of the relevant legislation.