업무정지처분취소
1. Of the instant lawsuit, the part of the claim for revocation of the disposition of 20 days of business suspension as of July 14, 2014 shall be dismissed.
2. The plaintiff's remainder.
1. Details of the disposition;
A. The Plaintiff is a doctor who opened and operates B Council Members on October 31, 2008 (hereinafter “instant Council Members”).
During the period from November 26, 2012 to December 7, 2012, the Defendant conducted an on-site investigation on the details of the instant member’s medical treatment during the period from October 1, 2010 to September 30, 2012.
(hereinafter “instant on-site investigation”). (b)
As a result of the instant on-site investigation, the Defendant confirmed that the instant member filed a false claim for the number of days of hospitalization, a false claim for hospitalization fees, etc., and a claim for violation of the calculation standard of food costs for inpatients, and filed a claim for violation of the calculation standard of medical care benefits and medical care benefits.
On June 23, 2014, the Defendant issued a 128-day disposition of suspension of business pursuant to Article 98(1)1 of the National Health Insurance Act (from September 1, 2014 to January 6, 2015; hereinafter “instant first disposition”) to the Plaintiff on the ground of false or unjust claims, and issued a 20-day disposition of suspension of business pursuant to Article 28(1)1 of the Medical Care Assistance Act (from September 1, 2014 to September 20, 2014; hereinafter “instant second disposition”).
▣ 이 사건 제1처분 사유 입원일수 거짓청구 13,418,000원 - 요양급여비용 청구 시 국민건강보험 관계법령 등에 의거 실제 진료한 내역을 정확히 기 록하고 청구하여야 하며, 수진자가 처방에 따른 입원 등을 하였는지 확인하고 그 비용을 부담하게 하여야 하나, 일부수진자의 경우 내원당일 방사선 촬영, 혈액검사 및 처치 등을 의사 처방에 따라 실시하고, 다음날부터는 내원한 사실이 없음에도 최초 내원 당일부터 입원하여 진료한 것으로 입원실을 지정하고 입원처방내역을 수기 진료기록부 등에 한꺼번에 기록하고, 입원일수를 증일하여 입원료 등을 청구하였으며, 수진자에게 그 비용을 징수하였다.
Unfair, such as hospitalization fees, and