1. Determination on the amount equivalent to the medical care benefit cost paid by health insurance subscribers, etc.

A. Without being asserted in the lower court, the assertion that the Defendant’s new argument was not a legitimate ground of appeal against the lower judgment cannot be a legitimate ground of appeal against the lower judgment. Thus, the argument that the Defendant’s instant disposition was included in an operating cost to deduct the radic surgery cost cost, the radic surgery cost, the external face, the main part, and the point of which were collected from the health insurance policyholder or his dependent on the ground that the Defendant had been paid to the Plaintiff by fraud or other improper means. Thus, the allegation that this part of the ground of appeal cannot be a legitimate ground of appeal.

B. The court below recognized that the plaintiff received 124,370 won separately from the expenses for medicine that occurred on the date of release from entrance in connection with the mass operation against the non-party 1 and 2 on September 2006. In light of the evidence submitted, the above fact-finding by the court below is just and acceptable, and there is no violation of the rules of evidence as argued in the Grounds for Appeal.

C. According to the reasoning of the judgment below, it is apparent that the court below did not apply the rules on the medical care benefits standards amended by Ordinance of the Ministry of Health and Welfare No. 428 of December 28, 2007 with respect to the above Razer operation expenses and the above medicine expenses, etc., and therefore, the prior argument on a different premise is without merit.

2. Determination on the amount equivalent to the medical care benefit cost paid by Defendant Corporation

Article 52 (1) of the National Health Insurance Act (hereinafter referred to as the “Act”) provides that “The Corporation shall collect all or part of the amount equivalent to the medical care benefit costs from a person who has received insurance benefits or a medical care institution that has received the insurance benefit costs by deceit or other improper means.” However, according to Article 43 of the Act, Article 12 and Article 13 of the former Enforcement Rule of the National Health Insurance Act (amended by the Ordinance of the Ministry of Health and Welfare No. 379 of Dec. 30, 2006; hereinafter the same shall apply), in order for a medical care institution to claim the payment of the medical care benefit costs, the Corporation shall submit to the Health Care Institution an examination request stating the amount equivalent to the medical care benefit costs, including the name of illness or injury, the date of commencement of medical care benefits, the contents and contents of medical care benefit costs, etc., which are submitted by the Health Care Institution for a maximum of 40 days from the Corporation without any specific circumstance that the Corporation would have received the medical care benefit costs from the Corporation.

Nevertheless, the court below rejected the plaintiff's assertion that it is justifiable to apply the disease classification number 157100 to the original diagnosis surgery on different premise, and that the plaintiff did not prove that the above surgery constitutes the disease classification number 157100. Thus, the court below erred by misapprehending the legal principles on the burden of proof when it collects all or part of the amount equivalent to the expenses of medical care for the reason that the medical care institution was paid with the medical care institution by fraud or other improper means under Article 52 (1) of the Act.

3. Conclusion

Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Ji-hyung (Presiding Justice)