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(영문) 서울고등법원 2017.11.15 2017누43700

요양급여비환수결정처분취소청구

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1. The plaintiff's appeal is dismissed.

2. The costs of appeal, including the part arising from the supplementary participation, are all assessed against the Plaintiff.

Reasons

Details of the disposition

The reasoning for this part is as stated in the reasoning of the judgment of the court of first instance. Thus, this part is cited in accordance with Article 8(2) of the Administrative Litigation Act and Article 420 of the Civil Procedure Act.

It is true that D and E were convicted of violation of the Medical Service Act, etc. on the ground that D and E were led to the establishment and operation of the Fvalescent Hospital, which is not the instant hospital, based on the Plaintiff’s assertion as to the legitimacy of the instant disposition.

However, as to the establishment and operation of the instant hospital, unlike the Fvalescent, it did not investigate the specific process of establishment or operation, and D, E, and Plaintiff et al. were not prosecuted due to the suspicion of violating the Medical Service Act. The actual owner of the instant hospital is E, and D only invested some of the funds at the request of E prepared for the establishment and operation of the instant hospital, and it did not actively take part in the establishment and operation of the instant hospital.

This is supported by the fact that E opens a Fvalescent under its own name, or that it independently approved the Fvalescent sheet, disbursement resolution, deposit slip, etc. without obtaining the approval of D, the president as the president, and that it is supported by the fact that E is the recipient of the assignment of claims, the notice of assignment of claims, the transfer of claims, or the payment of drugs in the E account, as revealed by the evidence of No. 12 to 18 (including branch numbers; hereinafter the same).

Therefore, the instant hospital does not constitute a medical institution established in violation of the Medical Service Act.

Even if the instant hospital was established in violation of the Medical Service Act, in order to apply Article 57(1) of the National Health Insurance Act to the Plaintiff, ① the Plaintiff should have actually conducted fraudulent or other improper means, and ② the Plaintiff should be a medical care institution that actually received insurance benefits costs.

① In relation to the above requirements, the Plaintiff is from E.