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(영문) 서울행정법원 2015.11.05 2015구합67281

장기요양급여비용 환수처분 취소청구

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1. The plaintiff's claim is dismissed.

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

Reasons

1. Details of the disposition;

A. From July 21, 2010, the Plaintiff operates the “C Care Center” (hereinafter “instant medical care center”) as a long-term care institution under the Act on Long-Term Care Insurance for the Aged-gun (hereinafter “Act”).

B. As a result of conducting an on-site investigation of the instant medical center from March 16, 2015 to January 19, 2015 (the target period: from February 2, 2012 to January 2015; hereinafter “instant investigation”), the Defendant and the Taean-Gun determined that “D, registered as the sanitation center of the instant medical center, worked for less than 160 hours a month as a sanitation center from April 2014 to January 2015, the Plaintiff registered D as the sanitation center, and received medical care benefit costs for additional assignment of human resources, additional placement of necessary human resources, and strengthening of night placement personnel from the Defendant for the said period.”

C. On May 6, 2015, the Defendant notified the Plaintiff that it would recover KRW 50,497,140 in total expenses for long-term care benefits pursuant to Article 43 of the Act.

(hereinafter “Disposition in this case”). 【No dispute exists, entry of Gap’s evidence Nos. 1 through 4, and the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The Plaintiff’s assertion D initially worked as a caregiver of the instant medical center on April 2014, while entering into a labor contract with the Plaintiff, and worked as a sanitarian for at least 160 hours a month thereafter. However, during the operation of laundry or drying machine, D was voluntarily engaged in duties, such as bathing and taking meals, in order to cooperate with the caregiver, and D did not need to hold concurrent office as a caregiver because it has sufficient human resources for caregiver of the instant medical center.

Therefore, the Plaintiff did not claim the cost of long-term care benefits to the Defendant by fraud or other improper means.