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(영문) 서울고등법원 2017.08.17 2016나2041270

부당이득금

Text

1.The judgment of the first instance shall be modified as follows:

The defendant shall pay to the plaintiff KRW 12,167,853 as well as to the plaintiff on June 2017.

Reasons

1. Basic facts

A. The Plaintiff is a doctor operating the “B hospital” in Gyeyang-gu Incheon, and the Defendant is a health insurance insurer established under Chapter III of the National Health Insurance Act.

B. On June 1, 2015, the Plaintiff may claim the Corporation for the payment of medical care benefit costs.

In such cases, the request for examination of medical care benefit costs under paragraph (2) shall be deemed the claim for medical care benefit costs for the Corporation.

(2) A medical care institution that intends to claim for medical care benefit costs under paragraph (1) shall file a request for review of medical care benefit costs with the Review and Assessment Service, and the Review and Assessment Service in receipt of a request for review shall promptly notify the NHIS and the

(3) The NHIS notified of the details of examination under paragraph (2) shall, without delay, pay medical care benefit costs to medical care institutions according to the details.

In such cases, if the amount of co-payment already paid is more than the amount notified under paragraph (2), the relevant subscriber shall be paid by deducting the amount paid more than the amount to be paid to the medical care institution.

As prescribed by relevant provisions, the Plaintiff filed a claim with the Health Insurance Review and Assessment Service (hereinafter “Review and Assessment Service”) for review of the payment of health care benefit costs on May 2015.

C. After examining the Plaintiff’s above request for review, on June 10, 2015, the Review and Assessment Service notified the Defendant of the payment of KRW 125,106,100 (i.e., KRW 21,180, KRW 185,30, KRW 123,229,590 (hereinafter “instant money”) to the Plaintiff on June 22, 2015, and the Defendant did not pay the instant money to the Plaintiff on June 22, 2015.

On June 2, 2017, the Defendant recognized that there was a debt equivalent to the instant monetary amount, and paid KRW 125,106,100 to the Plaintiff (hereinafter “instant repayment”).

[Ground for recognition] A.