보험급여비용 조정처분 취소 청구의 소
1. The Defendant’s disposition of reduction of KRW 13,024,357 for medical care benefit costs against the Plaintiff on January 2, 2012 shall be revoked.
1. Details of the disposition;
A. The Plaintiff is a juristic person that established and operated the Gangseo-hee University Hospital (hereinafter “instant hospital”), which is a health insurance medical care institution.
B. On September 20, 201, a doctor affiliated with the instant hospital diagnosed A (B) hospitalized in the instant hospital (hereinafter “the instant patient”) by using a computer screen film (CT) and self-copiction (MRI), etc., on the 22th day of the same month and the 29th day of the same month, he/she diagnosed the said patient by using cT screening of the vertecule brate cT, spin brate brate brate brates, side brates, and symptoms after the cirropical bropical brheat, etc. (hereinafter “the instant operation”). On the 29th day of the same month and the 29th day of the same month, he/she performed spinal surgery (hereinafter “the instant operation”). < Amended by Presidential Decree No. 20630, Sep. 20, 201>
C. The Plaintiff claimed medical care benefit costs for the instant surgery, and on January 2, 2012, the Defendant adjusted the amount of KRW 13,024,357 in total from the medical care benefit costs on the ground that the instant patient did not meet the criteria for recognition of “LDK” provided for in the Review Guidelines (hereinafter “the Review Guidelines”), which is published by the Ministry of Health and Welfare, on the grounds that the instant patient does not meet the criteria for recognition of medical care benefit costs and methods, and the test guidelines.
(hereinafter “instant disposition”) D.
On March 30, 2012, the Plaintiff filed an objection against the instant disposition with the Defendant, but the Defendant dismissed it on July 18, 2012.
E. On August 7, 2012, the Plaintiff dissatisfied with the foregoing, filed an appeal with the Health Insurance Dispute Mediation Committee on the following grounds: (a) on August 7, 2012, “In the case of the instant patient, the instant disposition was unlawful since the Plaintiff performed an operation with a dK due to the chronological depression and spine depression by using a typical chronic chronological chronological flusium, not the LDK in the instant case; (b) however, the Health Insurance Dispute Mediation Committee filed an appeal on August 2015.