보험급여비용삭감처분취소
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. Details of the disposition;
2. The plaintiff's assertion and the grounds for the court's explanation on this part of the relevant statutes are as follows, except for the part concerning "related statutes" of the court of first instance as stated below. Thus, this part of the reasoning of the court of first instance is identical to the corresponding part of the reasoning of the court of first instance. Thus, it shall be accepted in accordance with Article 8 (2) of the Administrative Litigation Act
12 One side of the National Health Insurance Act is "former National Health Insurance Act (amended by Act No. 13985, Jun. 3, 2016)".
13. The Enforcement Rule of the National Health Insurance Act is amended by the former Enforcement Rule of the National Health Insurance Act (amended by Ordinance of the Ministry of Health and Welfare No. 421, Jul. 27, 2016); and the “Rules on the Standards for Medical Care Benefits in National Health Insurance” is respectively amended by the former Rules on the Standards for Medical Care Benefits in National Health Insurance (amended by Ordinance of the Ministry of Health and Welfare, Sept. 28, 2018).
15 The term "medical care assistance" is regarded as "former Medical Care Assistance Act (amended by Act No. 14697, Mar. 21, 2017)".
3. Whether the instant disposition is lawful
(a) Where it is deemed necessary to provide medical treatment in consideration of the insured's age, gender, occupation, physical and mental conditions, etc., the relevant legal principles shall be provided based on accurate diagnosis within the scope medically recognized for the promotion of patient's health, and shall be provided in an economically and economically cost-effective manner;
Article 5 (1) [Attachment 1] of the former Rules on the Standards for Medical Care Benefits in National Health Insurance (Amended by Presidential Decree No. 595, Sep. 28, 2018)
1. General principles of medical care benefits. The appropriate medical care benefits payable are limited to cases that meet the criteria for recognition prescribed by the law, and are appropriate only to part of the expenses claimed by the defendant against the legal standards.