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(영문) 서울고등법원 2015.06.11 2014누4889

과징금부과처분취소

Text

1. Revocation of the first instance judgment.

2. The plaintiff's claim is dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Reasons

Details of the disposition

The plaintiff is a doctor to establish and operate a C Hospital in Gyeyang-gu Incheon Metropolitan City (hereinafter referred to as the "instant hospital").

On December 29, 2009, the Seoul Regional Police Agency notified the Defendant of the result of the epidemology test with respect to 68 persons H, etc. from around 2008 to around 2009 by falsely manipulating the result of the epidemology test with respect to 68 persons H, etc., thereby receiving medical care benefits equivalent to 49,300,40 won.

After conducting an on-site investigation of the instant hospital from January 1, 2009 to September 30, 2009, the Defendant imposed KRW 35,317,930 on the insurer for a total of 12 months from October 1, 201 to December 31, 2010, on the ground that the instant hospital imposed KRW 35,317,930 on the insurer by fraudulent or other unlawful means. On March 23, 2012, the Defendant rendered a disposition of imposition of penalty surcharge under Article 85-2 of the former National Health Insurance Act (amended by Act No. 11141, Dec. 31, 201; hereinafter referred to as “the Act”); Article 85-1 of the former Enforcement Decree of the National Health Insurance Act (amended by Presidential Decree No. 2407, Aug. 31, 2012; hereinafter referred to as “instant disposition of imposition of penalty surcharge”); Article 56(1)65 of the Enforcement Decree of the former National Health Insurance Act (amended by Presidential Decree No. 16757

The calculation details of unfair amounts presented by the defendant are as follows, and detailed details, such as the relevant winner and the date of inspection of the winner are as specified in the attached Table.

Unfair amount: 35,317,930 won - Details of calculation of the improper amount of KRW 35,317,930 - Claim 35,317,930 in violation of the standards for recognition of an operation of an amount of money required using artificial tape - The operation of an amount of money required using artificial tape is recognized as a epidemology test in cases where the main amount of money required for duplicating pressure, or duplicating pressure, is verified, and where the amount of money required for duplicating pressure is less than 120 cmH20,000, and if not included in the standards for recognition, all of the medical expenses, such as operation fees, hospitalization fees, and anesthesia fees, etc., are non-benefited, or if