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(영문) 서울고등법원 2018.06.27 2017누69733

실사요양급여비 환수결정취소

Text

1. Revocation of the first instance judgment.

2. On February 15, 2017, the Defendant issued a disposition to recover the actual medical care benefit cost to 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.

Between April 21, 2014 and April 25, 2014, the Health Insurance Review and Assessment Service conducted an on-site investigation of the instant hospital with respect to medical care benefit costs (hereinafter “the instant visit review”) to verify the details of claims for hospital tuition fees, facilities, human resources, and equipment (including hospital meals), medical care benefit costs, etc. Based on the result of the instant visit review, the term “the period subject to request from the Minister of Health and Welfare from April 2013 to October 2014”; and accordingly, the main reason for request was “the unfair request from non-service emergency human resources.” Accordingly, the Minister of Health and Welfare requested an on-site investigation with respect to the instant medical care institution from March 16, 2015 to March 20, 2015, during the period of investigation from April 2013 to April 3, 2014, and from October 14, 2014 to 2015 (hereinafter “the total period of investigation”).

On April 4, 200, the Minister of Health and Welfare reported to the Defendant that he/she worked for 6 days a week (6-10 hours a day prior to 9-10 hours ad o'clock, 3-4 hours ad o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock) from April 1, 2013 to March 31, 2014, while the Minister of Health and Welfare reported that he/she worked for o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock, o'clock

“The instant field survey results was notified by the Defendant, and the Defendant, on February 15, 2017, notified the Plaintiff pursuant to Article 57 of the National Health Insurance Act.