특정경제범죄가중처벌등에관한법률위반(사기)등
The judgment below
The part against the defendant shall be reversed.
Defendant shall be punished by imprisonment of one year and six months, and fine of twenty thousand won.
1. Summary of grounds for appeal;
A. In fact, misunderstanding of the legal doctrine and misunderstanding of the fact 1) The Defendant had a criminal intent to commit fraud since the Defendant had different knowledge that the act of claiming expenses for medical care or medical care benefits was committed while operating a pharmacy under the name of a pharmacist.
shall not be deemed to exist.
Even if the intention of fraud is recognized, it should be specified when the defendant begins to become aware of the criminal intent of fraud from time to time.
2) Even if patients who received medicine from the instant pharmacy operated by the Defendant prepared medicine at another pharmacy, the amount equivalent to the amount claimed by the Defendant against the victims was paid as expenses for medical care or medical care benefits, so there is no substantial property damage suffered by the victims.
B. The sentence sentenced by the lower court to the Defendant (two years of imprisonment) is too unreasonable.
2. Determination
A. As to the assertion of misunderstanding the facts and misapprehension of the legal doctrine, Articles 20 and 93(1)2 of the Pharmaceutical Affairs Act limit the qualification of a pharmacy founder to a pharmacist or an oriental medical doctor, thereby prohibiting a person who is not qualified to establish a pharmacy from establishing a pharmacy, and imposing criminal punishment for such violation.
In addition, Article 42(1)2 of the National Health Insurance Act limits one of the medical care institutions eligible for medical care benefits to “pharmacys established under the Pharmaceutical Affairs Act”. Thus, even if medical care benefits were provided at a pharmacy not established lawfully in violation of Article 20 of the Pharmaceutical Affairs Act, the relevant pharmacy does not constitute a medical care institution entitled to claim medical care benefits under the National Health Insurance Act, and thus, is not entitled to receive medical care benefits lawfully.
Therefore, it is reasonable to claim the National Health Insurance Corporation to pay the medical care benefit costs as if the pharmacy established by a person who is not a pharmacist is a medical care institution legally established under the Pharmaceutical Affairs Act.