요양급여비용환수고지처분취소
1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
The purport of the claim and appeal is the purport of the appeal.
1. The Plaintiff is a non-profit medical corporation that operates a hospital located in the Busan Suwon-gu (hereinafter “instant medical care institution”).
On September 2014, the Busan Commissioner of the Local Police Agency notified the Defendant of the investigation result that “The Plaintiff and B, the representative of the Plaintiff, obtained the total sum of KRW 4,572,430 in relation to false hospitalization of patients from the Defendant, as a whole, KRW 56,154,70 in relation to false claim for medical care benefit expenses, medicine expenses, and preparation fees.”
According to the above investigation, on October 24, 2014, the Defendant rendered a disposition to recover medical care benefit costs (hereinafter “the first disposition”) against the Plaintiff, based on Article 57 of the National Health Insurance Act (hereinafter “National Health Insurance Act”) with respect to KRW 4,471,120 remaining after deducting the amount already collected from the amount of medical care benefit costs of KRW 4,572,430 obtained by the Plaintiff on the grounds of restitution of insurance fraud, etc., and ② on November 3, 2014, the Defendant issued a disposition to recover medical care benefit costs of KRW 56,154,70, and KRW 53,774,30 remaining after deducting the amount already collected from the amount of medical care benefit costs of KRW 56,154,70, and the first and second dispositions of this case “each of the instant dispositions”).
The Plaintiff appealed to each of the dispositions in this case and filed an objection with the Health Insurance Objection Committee, but the Health Insurance Objection Committee dismissed the objection on March 25, 2015.
[Ground of recognition] Facts without dispute, Gap evidence 1, 29 evidence, Eul evidence 1 to 4, 14, and 15, the purport of the whole pleadings
2. Whether each of the dispositions of this case is legitimate
A. The Plaintiff’s assertion that the Defendant was not hospitalized in the instant medical care institution is unlawful inasmuch as the instant first disposition, which was the ground for recovering insurance fraud, was against the Plaintiff’s allegation that the patient was actually hospitalized in the instant medical care institution. If there was a false hospitalization, the patient is actually hospitalized during the period of hospitalization.