장기요양급여비용 환수처분취소
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 established and operated the “C Care Center” (hereinafter “instant medical care center”) which is a long-term care institution (long-term care communal living home for older persons) providing facility benefits under Article 23(1)2 of the former Long-Term Care Insurance Act (amended by Act No. 15881, Dec. 11, 2018; hereinafter the same) in Gyeonggi-gu, Gyeonggi-do.
B. From April 2, 2019 to April 5, 2019, the Defendant and the head of Pyeongtaek-gu conducted a field investigation on the provision of long-term care benefits and the claim for expenses, etc. of the instant medical care center (hereinafter “instant field investigation”) by setting the period subject to investigation from June 2, 2016 to September 2017, and from December 2, 2018 to February 2019.
C. On July 3, 2019, the Defendant issued a disposition to recover KRW 10,638,010 of the cost of long-term care benefits received by the instant medical care center based on Article 43(1)3 of the former Act on Long-Term Care Insurance for the Aged on the ground that the grounds for the following disposition are recognized based on the results of the instant
(1) After providing benefits pursuant to Article 6 and Article 7 of the notification of the criteria for providing long-term care benefits and the method of calculating expenses for long-term care benefits by increasing the number of service days and number of times (hereinafter “instant disposition”), the beneficiary D actually claimed expenses for long-term care benefits on December 1, 2018 through December 3, 2018 (3 days), and the Plaintiff unfairly claimed 89,520 won by claiming for the violation of the criteria for additional placement of human resources (unfair amount of KRW 10,515,320; hereinafter “the grounds for the instant disposition”), and applying for additional placement of human resources pursuant to Article 55 of the notification of the criteria for the provision of long-term care benefits and the method of calculating expenses for long-term care benefits.