요양급여비용환수결정처분 취소
1. The Defendant’s disposition to recover medical care benefit costs of KRW 7,937,360 against the Plaintiff on July 13, 2015 is revoked.
2...
1. Details of the disposition;
A. The Plaintiff is operating a Council Member C (hereinafter referred to as “instant Council Member”) in the Seoul Special Metropolitan City, Jeonju-si B.
B. On June 10, 2015, the Defendant received a notification of the investigation results stating that “The Defendant sent total of KRW 8,433,780, including the admission fees for 17 patients who provided treatment without actually hospitalized in the instant member, to the Defendant for medical care benefit and received the payment thereof,” from the Jeonju Police Station, to the Jeonju District Prosecutors’ Office.
C. On July 13, 2015, the Defendant issued a disposition to recover the pertinent medical care benefit cost pursuant to Article 57 of the National Health Insurance Act, on the ground that “the instant member was paid by the Defendant on the ground that he/she did not properly manage the costs of hospitalization to the J, E,F, G, H, H, I, K, L, M, N, P, P, P, P, Q, and R (other insurance companies from among the said 17 patients, with the exception of the part concerning S and T payment of medical care costs by other insurance companies; hereinafter referred to as “the instant patients”) but was paid by unfairly claiming for the medical care benefit costs, such as hospitalization fees, etc., pursuant to Article 57 of the National Health Insurance Act.”
(hereinafter referred to as "disposition of this case"). 【No dispute exists, Gap evidence Nos. 1, Eul evidence Nos. 1 and 2 (including branch numbers), the purport of the whole pleadings.
2. The parties' assertion
A. The gist of the Plaintiff’s assertion was that all of the instant patients need to be hospitalized, and the instant member received normal hospitalization.
Some of them were in the absence of permission during the period of hospitalization, but they were in the absence of permission, but solely because they were hospitalized, they received medical treatment for the entire period of hospitalization.
It is unreasonable to view that there is no need to be hospitalized or that there is no need to be hospitalized.In domestic affairs, even if the plaintiff claimed the medical care benefit as if the patient was hospitalized, it would be abuse of discretion to collect the medical care benefit from the actual part of the medical treatment.
(b) the defendant.