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(영문) 서울중앙지방법원 2017.04.13 2016가단5103869

부당이득금

Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Facts of recognition;

A. The Plaintiff’s reimbursement 1) The Plaintiff’s reimbursement of the medical care benefit cost against the Plaintiff is the “Csan Women’s Medical Center” on the fourth floor of the building in Namyang-si, Namyang-si (hereinafter “instant member”).

(2) On April 8, 201, the Minister of Health and Welfare issued an on-site investigation into the health insurance medical institution, including the instant member, in relation to the on-site gold operation, with a view to opening and operating medical care benefits, and claimed expenses for the Defendant. In relation to the on-site gold operation, the Minister of Health and Welfare notified the Plaintiff of an administrative disposition of 66 days in the suspension of business of the instant member pursuant to Article 85(1) of the former National Health Insurance Act (hereinafter “instant disposition of business suspension”), that the Plaintiff would recover 32,930,510 won, on the ground that the Plaintiff’s claim for the medical care benefits costs was discovered.

3) The calculation basis of unfair amounts presented by the Minister of Health and Welfare is as follows: 32,930,510 won: (a) detailed calculation basis of unfair amounts - KRW 32,930,510 - 32,930,510 which violates the standard of recognition for the operation using artificial tapes - Inception surgery using artificial tapes is recognized when the main mixed substance of dypology loss or dypology loss is confirmed through the epidemology test, and when the dypology is less than 120 cmH2O, and all the expenses for medical treatment, such as surgery fees, hospitalization fees, and anesthesia fees, if the results of the examination do not meet the standard of recognition, upon request from the staff of the equipment company, shall manipulate other patient data, such as hospitalization fees, anesthesia, date, time, results of the examination, etc., based on the results of the examination.