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(영문) 서울동부지방법원 2018.04.06 2017나27152

전부금

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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.

Reasons

1. The reasoning of the court's explanation concerning this case is as follows: (a) the statement "No. 14" in the 5th 5th 17th eth 17th eth eth eth 17th eth eth eth eth 17th eth eth eth eth eth eth eth eth eth eth 14 and the additional decision as to the grounds for appeal is added; and (b)

2. Additional determination

A. As to the method of evidence recognizing the so-called office-general hospital, the plaintiff asserts that the medical care institution is a so-called office-general hospital in violation of Article 33(2) of the Medical Service Act in light of the content of the provision of Article 47-2 of the National Health Insurance Act and the purpose of legislation, in order for the defendant to refuse the payment of insurance benefits or to recover the insurance benefits, it should be confirmed that it is a office-general hospital.

However, Article 47-2 of the National Health Insurance Act provides that "a case of confirmation as a result of investigation by an investigative agency" is merely a case where the defendant intends to withhold the payment of insurance benefits to a medical care institution for a violation of Article 33 (2) of the Medical Service Act.

Article 57 of the National Health Insurance Act, which allows a medical institution to collect the insurance benefits already paid on the ground of a violation of Article 33(2) of the Medical Service Act as unjust enrichment, does not stipulate "the investigation result of the investigative institution" as a requirement.

Meanwhile, the investigation result of the investigative agency is subject to the judgment of criminal liability. As in this case, the recognition of criminal liability is more strict and high in comparison with the case of civil procedure where there is no claim for insurance benefits on the ground of violation of Article 33(2) of the Medical Service Act. Therefore, in the judgment of civil procedure as to the absence of such claim, it is limited to the investigation result of the investigative agency.