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(영문) 서울고등법원 2018.06.27 2017누69726

과징금부과처분취소

Text

1. Revocation of the first instance judgment.

2. On December 26, 2016, the Defendant imposed a penalty surcharge of KRW 118,664,90 on the Plaintiff.

Reasons

Details of the disposition

The Plaintiff is a doctor to operate a C convalescent Hospital (hereinafter “instant hospital”), which is a medical care institution located in Guro-gu Seoul Metropolitan Government, from September 2007.

During the period from April 21, 2014 to April 25, 2014, the Health Insurance Review and Assessment Service: (a) conducted the visit examination of health care benefit costs (hereinafter “the visit examination in this case”) to the instant hospital by confirming the details of the claim for hospital tuition fees, facilities, human resources, and equipment (including hospital meals); and (b) the Defendant conducted an on-site investigation into the health insurance and medical benefits (hereinafter “the instant on-site investigation”) during the period from March 16, 2015 to March 20, 2015, with regard to the instant health care institution from April 16, 2013 to March 20, 2014 and from October 20, 2014 to December 2014 (hereinafter “the instant investigation period”).

Based on the results of the instant on-site investigation, the Defendant: (a) determined that the Plaintiff’s act constitutes “a case where the insurer, policyholder, or dependent bears the costs of health care benefit by fraud or other improper means”; (b) imposed a penalty surcharge of KRW 118,664,90, which is the amount equivalent to five times the costs of health care benefit claimed by the Plaintiff in lieu of the business suspension disposition under Article 99(1) of the National Health Insurance Act; (c) Article 70(1) and [Attachment Table 5] of the Enforcement Decree of the same Act on December 26, 2016; (d) Article 1-A, 2-A, and 3-A (a) of the criteria for business suspension and imposition of penalty surcharges on the Plaintiff; and (e) imposed a penalty surcharge of KRW 118,64,90,00, which

(hereinafter referred to as the "disposition of this case". The specific reasons of the Disposition of this case are as follows: 'Health Insurance's act' list of benefits and non-payment table and the point of relative value of benefits, Part 1 to Part 2, Section 17 of the point of relative value of the benefits.