요양급여비 환수처분 취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. On June 13, 2014, the Defendant rendered a disposition to recover medical care benefit costs (hereinafter “instant disposition”) as follows pursuant to Article 52(1) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 2011; hereinafter the same) on the ground that the Plaintiff, a medical doctor, lent the name necessary for the establishment and operation of a medical institution to B, who is not a medical person, and let the Plaintiff operate the “C convalescent hospital” (hereinafter “instant hospital”) as a so-called “office hospital” pursuant to Article 33(2) of the Medical Service Act.
The fact that there is no dispute over the amount of redemption decision of the period subject to redemption from April 201 to May 3, 2012 4,011 to May 5, 2012 4,011,506,540 [based on recognition], Gap evidence Nos. 1, 2, and 4, and the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. The Plaintiff’s assertion 1) The Defendant violated Article 23(1) of the Administrative Procedures Act by failing to present the basis and details for calculating the cost of recovery benefits, while rendering the instant disposition to the Plaintiff. 2) Article 52(1) of the former National Health Insurance Act provides that where a medical person gains profits without any legal cause, such profits shall be recovered. The Plaintiff provided medical treatment to the patient at the instant hospital and received medical care benefits from the Defendant and the patient, and thus did not gain profits without any legal cause.
3) 재량권의 일탈남용 구 국민건강보험법 제52조 제1항에 의하면 급여비용에 상당하는 금액의 일부에 대한 환수처분도 가능한 점, 이 사건 병원이 지급받은 요양급여비용에는 약제비나 재료비가 포함되어 있는데, 부당이득의 법리상 위 금액은 공제되어야 하는 점, 이 사건 처분으로 인한 환수 금액은 원고가 감당할 수 없을 정도로 과다한 점 등을 고려하면, 이 사건 처분은 재량권을 일탈남용한 것이다. ▣구 국민건강보험법(2011. 12. 31. 법률 제11141호로 전부개정되기 전의...