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(영문) 서울행정법원 2017.01.12 2016구합51191

업무정지처분취소

Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Details and details of the disposition;

A. The Plaintiff is operating “B” (hereinafter “instant long-term care institution”) under the Act on Long-Term Care Insurance for the Aged.

B. From April 6, 2015 to April 9, 2015, the National Health Insurance Corporation (hereinafter “Corporation”) and the Defendant conducted a field investigation on the details of long-term care benefits from January 6, 2014 to February 2, 2015, and determined as follows.

1. 2,270,430 won: 1.2,142,040 won: 2,142,040 won; 2.2,142,040 won; 3. 4,412,470 won in total of the grounds for disposition;

C. On June 19, 2015, the NHIS notified the Plaintiff of the content that “The Plaintiff shall recover KRW 4,412,470,00,00 in total of the expenses for long-term care benefits paid excessively due to the Plaintiff’s unfair or erroneous claim,” pursuant to Article 43 of the former Long-Term Care Insurance Act (amended by Act No. 13647, Dec. 29, 2015; hereinafter “former Long-Term Care Insurance Act”).

On July 30, 2015, the Defendant issued 20 days of business suspension (i.e., 50 days of business suspension) for 20 days of business suspension (ii) one month of business suspension (iii) pursuant to Article 37(1)3-2 and 4 of the former Long-Term Care Insurance Act to the Plaintiff.

(hereinafter “Disposition in this case”). [Ground for recognition] The fact that there is no dispute, Gap 1-3 evidence, Eul 1-7, and 28 evidence, and the purport of the whole pleadings.

2. Summary of the plaintiff's assertion

A. The Plaintiff did not have a reason for disposition and received expenses for long-term care benefits from the NHIS by fraud or other improper means, and there is no fact that some beneficiaries have reduced or exempted the amount of co-payment.

B. The criteria for providing long-term care benefits and the calculation method thereof, which are the basis for the disposition of this case.