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(영문) 서울행정법원 2020.01.16 2019구합54672

장기요양급여비용환수결정 취소

Text

1. All of the plaintiff's claims are dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is establishing and operating the “Medical Care Center” (hereinafter “instant Center”) which provides the “re-paid benefits” prescribed by the former Act on Long-Term Care Insurance for the Aged (amended by Act No. 15881, Dec. 11, 2018; hereinafter the same) in the Hahbuk-gun D, Chungcheongnam-do, and the “C Care Center” which provides the “facility benefits” prescribed by the said Act (hereinafter “instant Center”) and the “C Care Center” which is a medical care communal home for the elderly who provides the “facility benefits” prescribed by the said Act (hereinafter “the instant medical care center”).

B. From April 9, 2018 to April 13, 2018, the Defendant and the head of the voice Gun conducted a field investigation on the instant center and the instant medical care center (hereinafter “instant field investigation”) by setting the period subject to investigation from March 9, 2015 to February 2, 2018.

C. On November 28, 2018 based on the results of the instant on-site investigation, the Defendant: (a) decided to recover KRW 23,510,410 of the unfair cost of long-term care benefits to the instant center pursuant to Article 43 of the former Long-Term Care Insurance Act on the ground that the Plaintiff was unfairly claimed for expenses for long-term care benefits as indicated below; and (b) decided to recover KRW 9,343,210 of the unfair cost of long-term care benefits to the instant hospital; (c) however, each of the above dispositions was not served on

[Attachment 1] The Reasons for Disposition of the Name of Medical Care Institution (23,510,410 won in total) 1) The instant Center (hereinafter “Specialized Liability Insurance”) did not purchase a claim (an unfair amount of 587,080 won in the case of employees E) without deducting the subscription period of the Liability Insurance for Specialized Personnel related to Visit (hereinafter “Specialized Liability Insurance”) and provides the beneficiary F with services, in the case of employees G, without purchasing the Beneficiary Liability Insurance for Specialized Personnel from January 4, 2016 to January 14, 2016, in the case of not purchasing the Beneficiary Liability Insurance for Specialized Personnel, from July 6, 2015 to October 28, 2015, the beneficiary H and I provided services to employees, and in the case of employees J, even without purchasing the Beneficiary Liability Insurance for Specialized Personnel.