장기요양급여비용 환수결정처분 취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. Details of the disposition;
A. The Plaintiff is operating a “C” (hereinafter “C”) which is a long-term care institution that provides facility benefits under the Act on Long-Term Care Insurance for the Aged in the first floor among the second floor located in Suwon-si, Suwon-si (hereinafter “instant building”).
B. From December 19, 2016 to October 22, 2016, the Suwon Mayor conducted an on-site investigation of the instant sanatorium (the period subject to investigation: June 2015 to October 2016; hereinafter “instant on-site investigation”) with the Defendant, and as a result, determined that the Plaintiff received KRW 11,595,570 for long-term care benefit costs by fraud or other improper means as follows:
1. Despite the fact that the fixed number of admission to the sanatorium of this case was five persons in violation of excess of the fixed number, the beneficiary D filed a claim for expenses for benefits without reduction according to the excess of the fixed number for the pertinent period, even though the actual number of admission to the sanatorium of this case exceeds six persons from October 10, 2016 to October 31, 2016, when the beneficiary E was admitted respectively from October 17, 2016 to October 31, 2016.
2. Violation of standards for placement of human resources;
A. Although the assistant nurseF served in September 2015, it was falsely registered that it had worked until October 2015 and claimed expenses for benefits.
B. A nursing assistant G provided meals, etc. to senior citizens residing on the second floor of the instant building, not a person admitted to the instant sanatorium for one hour during the period of service, but he/she claimed expenses for benefits by including them during working hours until that time.
C. A caregiver had worked until April 19, 2016, but filed a false registration fee by May 2016. D.
A caregiver I and J filed for reimbursement costs by filing a false registration with them from October 2015 to November of the same year, and from June 2016 to August of the same year, even though they did not have worked at the sanatorium of this case.
(e).