2. The costs of the lawsuit are assessed against the defendant.

(a) Details of the disposition;

(1) The Plaintiff established and operated the Indonesian Hospital attached to the Ondones University (hereinafter “Plaintiff Hospital”) under the Medical Care Assistance Act, in accordance with Article 62, Yeongdeungpo-gu Seoul, Yeongdeungpo-gu, Seoul.

(2) From April 1, 2006 to September 30, the Defendant conducted an on-site investigation into the details of the medical benefits for the above patients of the Plaintiff hospital (i.e., e., e., e., e., e., thmathal typhal typhal typhal typhosis, lephal typhal typhal typhical typhrosis, chronic typhal typhal typhrosis, chronic typhrosis, chronic typhrosis, etc. (hereinafter “blood disease”), and determined that the Plaintiff hospital’s above patients’ medical benefits application standards and methods (hereinafter “the Ministry for Health, Welfare and Family Affairs’s medical benefits standard rules”; (ii) details of the medical benefits payment standard rules; and (iii) the payment standard provision of the aforementioned benefits standard rules; and (iv) the medical benefits payment standard provision of the Medical Care Benefits Act, in violation of the aforementioned benefit standard regulations; and (iv) the examination or treatment standard provision of the Medical benefits.

(3) Accordingly, on February 27, 2008, the Defendant imposed penalty surcharge of KRW 4,46,507,300 on the Plaintiff pursuant to Articles 28(1)1 and 29(1) of the Medical Care Assistance Act (amended by Act No. 8852, Feb. 29, 2008; hereinafter the same shall apply), Article 33 of the Enforcement Rule of the said Act (amended by Ordinance of the Ministry of Health and Welfare No. 441, Feb. 28, 2008; hereinafter the same shall apply), and attached Table 3 of the Enforcement Rule of the said Act (amended by Ordinance of the Ministry of Health and Welfare No. 4441, Feb. 28, 2008; hereinafter “instant disposition”).

Schedule of Calculation

1,271,76,7101, 236, 966, 966, 148, 883, 576, 507, 300, 294, 257, 257, 297, and 300, 294, 257, 6263, 826, 1,821, 829, 8294, the total amount of expenses for medical treatment treatment included in the table table included in the main sentence, and the average monthly amount of expenses for medical treatment (%) for the suspension of business of 11,271, 76, 710, 710, 2360, 280, 360, 370, 106, 196, 370, 196, 10, 370, 106, 196, 370, 106, 75, 16, 70, etc.

* The difference between the aggregate amount of the undue amount and the aggregate amount of the undue amount of each unfair claim according to the table of the calculation details is generated in the course of the fraction of national funds

B. Violation of the Plaintiff hospital’s medical treatment, payment criteria, and permission requirements

(1) Treatment of patients suffering from blood diseases, such as leukosis in the Plaintiff hospital

(A) The Plaintiff’s hospital and its umbrella organ transplant center are medical institutions specialized in blood diseases, such as leuk transfusions, etc. whose recovery is listed at the highest level through the Republic of Korea and abroad by performing the 3,129 funeral surgery by 197, including the Plaintiff’s hospital and its umbrella organ transplant for the first time in 1983, following the success of the same transplant of the lecopic lecopic lecopic lecopic lecopic lecopic lecophers in 194.

(B) The organ transplant surgery is currently recognized as the only treatment method for patients suffering from blood diseases, such as leuk-cell diseases, at the present. ① Blood transfusions through the inserting of alley and leuk-guer, ② Madral ambrosis ? ? Madral ambral ambr. ④ The procedure is implemented through the following characteristics, which are different from the treatment for lebral lebrosis in the process of the process:

(1) In order to prevent the recurrence of a somatic-cell transplantation, an abnormal dystrophy cell shall be complete dystrophy (the dystrophy of blood patients, such as leuk-dystrophy's disease, and leuk-dystrophy's dystrophy's dystrophy from the end blood), and the relevant Acts shall be implemented

(2) The combined and thorough aviation cancer treatment is provided. Accordingly, since the patient’s aggregate water is all destroyed and the immunity function is considerably far away compared to normal, even if it is infected by another disease, the maintenance of life is at risk. Therefore, thorough and adequate prevention, i.e., preventive and preemptive treatment should be provided to block infections of other diseases.

③ The above long-term multi-level therapy causes considerable pain to patients.

(C) The medical professionals of the Plaintiff Hospital mobilized all applicable medical means in line with the individual conditions of blood patients, such as leuk-patients, taking into account the above special characteristics, and as a result, from April 1, 2006 to September 30, 2006, the medical professionals of the Plaintiff Hospital claimed expenses other than the individual charges and non-benefit costs under the Medical Care Assistance Act, as stated in the above calculation statement.

(D) The above actions may be classified into the types of claims for reimbursement of expenses for medicines violating the payment criteria and permitted matters (2) and the types of claims for separate calculation of expenses (4.0 out of unfair calculation), the types of claims exceeding the standard amount (1,3,5 through (9) out of unfair calculation), and the types of claims for selective medical fees (1).

(2) Types of claims for reimbursement of pharmaceutical expenses in violation of benefit standards and permitted matters (unfair details)

(A) This type is the act of a medical institution arbitrarily prescribing and dumping to the patient beyond the permissible scope and standards of the relevant drug and receiving the expenses from the patient in full, although the effectiveness and safety of a certain drug have already been verified medical and objectively, and the allowable scope and standards of the relevant drug have been determined by the wage standards and permitted matters.

(B) The medical professionals in the Plaintiff hospital prescribed and administered 32 drugs for the treatment of patients with blood diseases, such as leukosiss, beyond the permissible scope and criteria set forth in the wage standards and permission requirements, and received all the expenses from the patient.

(C) The representative cases are as follows:

With respect to the provision of medical supplies within the main sentence, the method of preventing cirrosis infection, the method of preventing cirrosis cirrosis infection, the method of preventing cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis, or the method of preventing cyrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis, or the method of preventing cyrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis infection cirrosis, or the method of preventing cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis cirrosis.

(3) Type of separate claim for costs not to be calculated separately (unfair, 4, 00)

(A) This type of medical treatment is an act of receiving the cost of the material for medical treatment, equipment, etc. from the patient in addition to the amount determined in the public notice, since the cost of the material for medical treatment or the cost of using the material for medical treatment is already determined to be included in the number of the given medical treatment in the benefit standard, the Ministry of Health, Welfare and Family Affairs’s list of benefit and benefit points of the health insurance act, which is the public notice of the Ministry for Health, Welfare and Family Affairs (hereinafter “public notice of act fees”).

(B) The medical professionals in the Plaintiff hospital performed a thalthmosis, transplant surgery, central beer insertion surgery, etc. for blood patients, such as balone’s disease, while using the materials or equipment of 43 items, such as NEES-BOE MAMA MAPS (MN), operation balones, and C-RAM and video cirroption equipment, which provide that the cost of the treatment materials or equipment cannot be separately calculated and claimed for the treatment materials or equipment in the public notice.

(C) The representative cases are as follows:

Recognizing that there are more than one patient's non-complosion surgery at the location of the Plaintiff's 201 KING (XED) 40406 metrology surgery, for the purpose of calculating the 1 or more of the 1stral recovery surgery on the part of the patient with a large weight level of 1 or more of the 6thral recovery surgery, for the purpose of calculating the 1 or more of the 6thral treatment equipment of the Plaintiff hospital, for the purpose of calculating the 1 or more of the 6thral treatment equipment of the Plaintiff hospital, for the purpose of calculating the 1 or more of the 5thral treatment equipment of the 201stal treatment equipment of the Plaintiff hospital, for the purpose of calculating the 1 or more of the 5thral treatment equipment of the 6thral treatment equipment of the 201stal treatment equipment of the 1stal, for the purpose of calculating the 5thral treatment equipment of the 1stal treatment equipment of the 201stal.

(4) Type of claim that exceeds the standard amount (1), (3, (5) through (9)

(A) This type of medical institution’s arbitrary prescription, medication, and use of medical supplies, materials for medical treatment, examination, injection, etc., which are set forth in the benefit standard, and the cost for medical benefits performed within the scope not exceeding the benefit standard is charged to the market et al., but also to the cost for medical benefits performed within the scope not exceeding the benefit standard.

(B) The Plaintiff hospital prescribed, administered, and used blood disease patients, such as lebal diseases, in excess of the permissible amount of medicine, materials for medical treatment, examination, injection, etc., which are set forth in the wage standard, and received full payment from the patients. The Health Insurance Review and Assessment Service, in the process of examining the previous medical expenses, has previously rendered an example of reducing the medical expenses by judging the above medical expenses of the Plaintiff hospital as excessive treatment. However, the Plaintiff hospital anticipated the reduction of the medical expenses for the above type of medical treatment based on the previous case of reducing the medical expenses and claimed full payment to the patients without claiming the market, etc. for the medical expenses incurred within the scope that does not exceed the wage standard, and the representative case is as follows.

As a result of the examination of the Plaintiff’s disease, such as reimbursement standards/explosion surgery, which is included in the main text, it is necessary to check whether the 1-6-day infectious disease of the Plaintiff’s disease was infected by scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic s

(C) The Defendant: (a) added up the amount to be borne by the Mayor, etc. regarding the above medical treatment performed within the scope not exceeding the payment standard for medical treatment, such as pharmaceutical products, materials for medical treatment, examination, injection, etc., within the scope that exceeds the payment standard; and (b) deemed the amount to be an unfair claim; and (c) the costs equivalent to the rate of the principal’s burden among the medical treatment performed within the scope not exceeding the payment standard

(5) Type of unfair claims for selective medical fees (1)

(A) This type is that an institution providing medical benefits receives selective medical treatment applications from patients only with respect to the main medical treatment and doctor, and the main medical doctor and selective doctor choose the patient to provide medical treatment assistance and doctor with respect to the patient’s examination, such as examination and video diagnosis, but also claims the patient for selective medical treatment costs in addition to the main medical treatment and care.

(B) The form of the Plaintiff hospital’s application for selective medical treatment is divided into “the content of selective medical treatment” into “1. Medical examination, treatment, surgery, medical care, examination on February, 2, 3. Video Examination, 4. Radiation Fees, 5. anesthesia, and 6. Mental Health Act,” and the relevant medical department separately has a room for the patient to enter whether to apply for selective medical treatment and the name of the doctor in charge of selective medical treatment depending on whether to apply for selective medical treatment or not, and the patient’s name may be directly entered in and signed or sealed by the patient.” The form of the above application is written with the letter stating that “The doctor selected by the applicant requests the designation of the doctor in charge of selective medical treatment for the purpose of the patient’s medical treatment, and the doctor bears the burden of selective medical treatment fees imposed on the medical examination and treatment provided by the elective doctor (examination, video examination fees, radiation treatment, anesthesia, mental therapy, and other selective method).”

(C) Most of the patients who were enrolled in the Plaintiff hospital filed an application for selective medical treatment only with the primary medical care and doctor, and did not directly choose the direct medical care support and doctor. In that case, the patient explained that the primary medical care and doctor chosen by the patient may delegate to the patient the choice of the doctor with the medical care support and doctor, and with the consent of the patient, the patient selected the doctor with the medical care support and doctor in charge.

(c) Changes in the payment standards, permitted matters, etc.

(1) Type of claim for drug costs in violation of benefit standards and permitted matters

(가) 피고는 원고 병원에 대한 현지조사를 종결한 후 원고 병원 등의 신청에 따라 원고 병원이 급여기준·허가사항을 위반하여 사용한 의약품에 관한 의학적 타당성을 심사하였고, 그 결과 아래 표와 같이 10가지 의약품에 관하여 원고 병원이 처방·투여한 방법대로 급여기준·허가사항을 변경하였고, 4가지 의약품에 관하여 일부 변경하였으나, 9가지 의약품(마이폴틱 장용정 180mg·360mg, 부설펙스주, 자베도스주, 캠푸토주 100mg·40mg, 펜타미딘 이세치오네이트주, 플루다라주, 하이캄틴주)에 관하여는 원고 병원의 처방·투여 방법이 의학적 타당성을 인정할 수 없다는 이유로 급여기준을 변경하지 않았으며, 4가지 의약품(동아푸로스탄딘주, 메갈로텍주 250IU·500IU, 산도스타틴주)에 관하여는 의학적 타당성에 대한 검토를 하지 않았다. 한편, 원고 병원은 5가지 의약품에 관하여는 원고 병원이 처방·투여한 방법에 의학적 타당성이 없음을 자인하고 있다.

On July 1, 2007, 2007, an additional 000 gl.m. 20 g. 4m. 4m. Gaz. 4m. Gaz. 4m. Gaz. 4m. Gaz. 5m. Gaz. 4m. Gaz. 4m. Gaz. 5m. Gaz. 4m. Gaz. 5m. Gaz. 4m. Gaz. 4m. Gaz. 8m. Gaz. 8m. Gaz. 4m. Gaz. Gaz. 4m. Gaz. Gaz. 4m. Gaz. 4m. Gaz. 4m. Gaz. Gaz. 4m. Gaz. Gam. Gam. 4m. Gam.

(B) From July 1, 200 to introduce and implement the application system for determination of medical care benefits for new medical technology, etc. (the existing name is the application system for determination of non-determination, etc.) from July 1, 2000, where a new treatment act is newly developed in terms of clinical usefulness and cost-effective aspect, such as reducing treatment treatment period and reducing treatment period, etc., the institution providing medical care applied for a decision on whether a new act is eligible for benefits or a new act that has not been decided non-benefit, and if it falls under the scope of eligibility for benefits, it would be able to obtain a decision on the relative value of benefits (Articles 10 and 11 of the Regulations on Standards for Benefits).

(C) The introduction and implementation of the pre-application system on psychotropic cancer has been made from January 9, 2006, so that the scope of the relevant medicine, prescription, and medication (in the case of psychotropic cancer, etc.), matters permitted or reported under the Pharmaceutical Affairs Act and subordinate statutes, matters determined and publicly notified by the Defendant, and matters publicly notified by the head of the Health Insurance Review and Assessment Service, but, if particularly necessary for treatment of the relevant patient, medical institutions were able to prescribe and administer the relevant medicine within the scope recognized by the head of the Health Review and Assessment Service after submitting data on the name of the relevant medicine and the scope of prescription and administration, etc. of the relevant medicine (amended by Ordinance No. 328 of the Ministry of Health and Welfare on October 11, 2005). However, medical institutions are able to make a prior application only when the details on the payment standard are publicly notified, but only 3.7 years after the establishment of the blood and disease benefit system and 0.7 years after it was publicly notified.

(D) Where the application system for approval of non-benefits for general pharmaceutical drugs intends to prescribe and administer a medicine beyond the scope permitted or reported under the Pharmaceutical Affairs Act by introducing and implementing the benefit standard rules from August 1, 2008 through the amendment of the benefit standard rules, the institution providing medical benefits would be able to treat the medicine as non-benefits if it has obtained approval of non-benefits by proving medical grounds, etc. in accordance with the procedure determined and publicly notified by the Defendant (see attached Table 2 of the benefit standard rules (amended by Ordinance of the Ministry of Health, Welfare and Family Affairs No. 50, Jul. 11, 2008).

(2) The separate cost-sharing type

(A) On January 1, 2008, the Defendant: (a) pursuant to the Ministry of Health, Welfare and Family Affairs Notice No. 2007-124 on January 1, 2008, as to NEEDLE-BOMA MAPS (MN) 11G x 10cc x 13G x 10cc x 10cc x 10cc x 10cc x 10cm; (b) changed the number of the relevant activities so that it can be separately calculated and permitted to receive from the patient; (c) as to the 24 parts of the 24 parts of the 24 parts, the Defendant did not permit the patients to separately calculate the expenses incurred in using other materials, equipment, etc.

(B) In a case where a new high-priced material for medical treatment is developed in terms of clinical usefulness and cost-effective aspects, such as the introduction and implementation of the medical care benefit determination application system for new medical technology, etc. (the existing name is an application system for determination of non-determination, etc.) from July 1, 2000 following the enactment of the benefit standard rule, the medical institution may request the Defendant to determine whether a new material for medical treatment that has not been determined as an eligible for benefits falls under the eligible for benefits, and obtain a determination of the relative value of benefits, maximum amount of the material for medical treatment, etc. (Articles 10 and 11 of the benefit standard rule).

(C) Since July 1, 200, the health care benefit adjustment system for new health care benefit for medical technology, etc. was enforced since July 1, 2000. If new materials for medical treatment are developed that can replace the existing materials for medical treatment that are already included in the number of acts and for which separate calculation is impossible, if it is necessary to adjust the number of acts because the existing materials for medical treatment cannot be compensated for the newly developed high-priced materials for medical treatment, it may obtain a decision that the expenses for medical treatment can be reflected in the number of acts or separately calculated (Article 12 of the Benefit Standards Rules).

(3) Type of unfair claims for selective medical fees

(A) The Rules on Optional Medical Treatment (amended by Ordinance of the Ministry of Health, Welfare and Family Affairs No. 78, Nov. 28, 2008) stated in the form of selective medical treatment application that "if the applicant delegates the principal medical department and doctor to select a medical doctor, he/she shall consent to the principal medical treatment and doctor's medical support and choice, and bear additional expenses imposed on the medical care support and doctor's medical care (such as examination, video diagnosis, radiation treatment, anesthesia, and mental therapy).* Preparation of the same text stating that "only if the principal medical department and doctor delegate the selection of an alternative medical doctor with the medical care support to the principal medical doctor, the applicant shall sign or affix his/her seal thereon."

(B) The Plaintiff hospital changed the form of elective treatment application in line with the above revised form.

[Ground of recognition] Facts without dispute, Gap evidence Nos. 3, 4, 13, 15, 18, 19, 32, 37, Eul evidence Nos. 2 and 4, and the purport of the whole pleadings

2. The assertion and judgment

A. The plaintiff's assertion

The instant disposition shall be revoked on the grounds that it is unlawful for the following reasons.

(1) Non-existence of grounds for disposition

The act of the Plaintiff hospital, which was the premise of the instant disposition, cannot be deemed to constitute “when the Plaintiff hospital, etc., imposes expenses for benefits on the beneficiary, etc. by accelerating or by any other wrongful means,” as prescribed in Article 28(1)1 of the Medical Care Assistance Act.

(a) the type of claim for the costs of pharmaceutical products in violation of the benefit standard and permitted terms, the separate type of claim for the cost not to be calculated, and the type of claim exceeding the standard

① A blood disease, such as lebal diseases, is difficult to completely recover from or seek his/her life from blood patients, such as lebal diseases, only with medical treatment within the scope determined by the standard of benefits or the matters permitted. As such, a medical institution is obligated to provide the patient with the optimal medical treatment required medically even though the patient violated or exceeded the standard of benefits for the treatment of the disease, and thus, a medical institution is obliged to provide the patient with the patient with the medical validity and inevitability. Therefore, if the method of medical treatment is equipped with medical feasibility, it is difficult to provide the patient with the highest

② The diagnosis and treatment of the Plaintiff hospital, which is the premise for the instant disposition, can be deemed as having proved medical feasibility and inevitability in advance and later based on various thesiss, clinical trial results, and the result of the Defendant’s examination.

③ In light of the unique characteristics, depth, urgency, etc. of the treatment of blood patients, such as leuk transfusions, there is no time for the Plaintiff hospital to undergo the procedure, such as filing an application for determination of medical care benefits for new medical technology, etc. and filing a prior application for rhetoric cancer, and thus, the medical validity and inevitable nature cannot be rejected on the ground that

④ Ultimately, the Plaintiff hospital violated the payment criteria and the permission requirements, and conducted medical treatment with medical validity and inevitability, and cannot be compensated by the mayor, etc., and there is no express provision that it cannot claim the relevant expenses from the patient under the relevant Acts and subordinate statutes. Therefore, the Plaintiff is entitled to claim the relevant expenses and remuneration from the patient according to the contract entered into with the patient.

(B) Type of unfair claims for selective medical fees

(1) Since selective medical care costs are classified as non-benefit items under relevant Acts and subordinate statutes, they are received through private contracts between medical institutions and patients, and they are not received as costs for medical care.

② Not only are the forms prescribed by the amended elective treatment rules, but also can be deemed that patients comprehensively delegate the matters concerning support for medical treatment and choice of doctors to doctors in charge of elective treatment, even based on existing forms.

(2) A deviation or abuse of discretionary power (preliminary assertion)

If the Plaintiff hospital provides medical treatment in accordance with the wage standard that limits the volume, frequency, adaptation, inspection items, etc. of the medicine when treating an incurable disease, such as lebal disease, the patient’s life and health is limited, and it inevitably exceeded the benefit standard or conducted medical treatment in violation of it. The patient’s charge claimed by the Plaintiff hospital to the patient is merely the actual transaction level of medicine and materials, and thus, separate profits are not generated in the Plaintiff hospital. In light of the fact that the Plaintiff hospital contributed to the treatment of blood diseases such as lebalosis, etc. and the development of academic circles, the instant disposition imposing a penalty surcharge of five times the total unfair amount, which is the upper limit stipulated in Article 33 [Attachment Table 3] of the Enforcement Rule of the Medical Care Assistance Act, was excessively harsh, and thus, deviates from and abused discretion.

B. Defendant’s assertion

The instant disposition is lawful for the following reasons.

(1) The existence of the reasons for the disposition

The act of the Plaintiff hospital, which was the premise of the instant disposition, constitutes “when the Plaintiff hospital imposes expenses for benefits on the beneficiary, etc. by accelerated or other unjust means” under Article 28(1)1 of the Medical Care Assistance Act.

(a) the type of claim for the costs of pharmaceutical products in violation of the benefit standard and permitted terms, the separate type of claim for the cost not to be calculated, and the type of claim exceeding the standard

(1) Under the current national health insurance system or the medical care system in Korea, medical institutions are not allowed to violate the standard of benefits or conduct medical treatment exceeding permitted matters for the treatment of patients. The same applies to medical treatment with medical feasibility and inevitability. Even if medical treatment is permitted with medical feasibility and inevitability, medical feasibility and inevitability of the Plaintiff hospital cannot be recognized.

(2) Although a medical institution violates the payment standards or provides medical treatment in excess of the permitted matters or uses materials for medical treatment, it is recognized in advance through procedures such as filing an application for the determination of medical care benefits for new medical technology, etc. and filing an advance application for anti-clibral cancer, the Plaintiff hospital

③ The Plaintiff hospital’s medical treatment in violation of the benefit standard or beyond permitted matters, or using materials for medical treatment, etc., and claiming all the expenses to the patient under an agreement with the patient is not allowed in light of the purport of the relevant provisions

(B) Type of unfair claims for selective medical fees

① The Plaintiff hospital’s patients cannot be deemed to comprehensively delegate the matters concerning the provision of medical treatment and the choice of doctors to the doctor in charge of selective medical treatment. Moreover, the patient was in a state of being unaware of the patient’s medical support and choice of doctors. Therefore, the patient was unable to exercise his/her right of choice appropriately.

② Although selective medical expenses are classified as non-benefit items under relevant Acts and subordinate statutes, such expenses cannot be claimed to the patient, since they fail to meet the aforementioned requirements.

(2) A legitimate exercise of discretionary power

In light of the fact that the instant disposition was conducted in compliance with the guidelines for imposing penalty surcharges under the Enforcement Rule of the Medical Care Assistance Act delegated by the said person, and that the damages incurred to the Plaintiff hospital compared to the public interest to be achieved due to the instant disposition cannot be deemed harsh, it cannot be deemed that the instant disposition was an abuse of discretionary authority.

(c) Related statutes;

Attached Form is as shown in the attached Form.

D. Determination

(1) Type of claim for drug costs in violation of benefit standards and permitted matters

(A) The purpose of the Medical Care Assistance Act is to contribute to the improvement of national health and the promotion of social welfare by providing medical benefits to those who have difficulties in living (Article 1 of the Act). To this end, an institution providing medical benefits is required to provide beneficiaries with medical benefits such as diagnosis, examination, medication, provision of materials for medical treatment, treatment, surgery, etc. in accordance with the benefit standard rules (Article 7(1) and (3) of the Act, Articles 6(1) and 9 of the Enforcement Rule of the Act, and Articles 6(1) and 9 of the Enforcement Rule of the Act). Expenses for medical benefits calculated by applying the point of relative value in the unit price of the medical care benefits to the benefit amount calculated by applying the point of relative value determined in the public notice with the national subsidy, the medical care fund created by a local government, and if part of the medical care fund is borne by the patient himself/herself, the remainder of expenses shall be collected from the beneficiary and refunded to the beneficiary as unjust enrichment (Article 23(2) of the Act, Article 9(2) of the Act).

(B) The purport of the aforementioned medical care provision and the following medical care provision, namely, ① the medical care system intends to provide citizens who have difficulties in living with an appropriate cost at a reasonable level through the Medical Care Fund created with limited financial resources, such as national subsidies. Under the current medical care system, it is possible to determine whether each individual medical treatment or the use of medicines or materials for medical treatment is eligible for benefits, and to arbitrarily determine the contents and costs of medical care under the current medical care system that is “medical treatment necessary for life” or “medical treatment with medical feasibility and inevitable” under the current medical care system that provides for medical care benefits system. ② Medical treatment is conducted against an unspecified number of patients who have professional knowledge and skills without knowledge about disease, etc.; ② Medical care act is conducted by a medical institution and a patient who has difficulty in receiving medical care benefits under a mutual aid agreement with the eligible recipient of medical care benefits without any special circumstance that allows the examination of the medical care institution and the patient to arbitrarily obtain benefits from the eligible recipient of medical care benefits in violation of the standard and procedure prescribed by the Act.

(C) However, there may be limitations in the method of treatment in modern medical science, such as infinite disease or incurable disease, and the treatment process of which is directly connected to the patient's life, only based on the existing standard of benefits and permission. In such a case, a medical institution in charge of treatment is able to sufficiently explain the meaning and necessity of treatment in violation of the standard of benefits prior to the patient's life, and to seek prior consent to the implementation thereof, and to prescribe and administer medicines after seeking the prior consent to the implementation thereof. If the above legal principle applies to such special cases without exception, it is highly probable that the treatment can infringe on the patient's right to life or the special right to choose a specific right to life or the right to choose an occupation at his own expense and infringe on the patient's fundamental right to property.

(1) Medical practice requires highly specialized knowledge, skills, and experience, and the Medical Service Act provides that only a medical person with professional qualifications can perform medical practice (Articles 5 and 25 of the Medical Service Act), and that the choice and implementation of medical practice that meets a disease shall be entrusted to a medical personnel, and no person shall interfere with such medical practice (Article 12(1) of the Medical Service Act), except as otherwise expressly provided for in Acts and subordinate statutes (Article 12(1) of the Medical Service Act), and that a medical personnel guarantees a specialized medical practice of a medical personnel. As such, a medical personnel has the freedom to perform occupation that enables a person to professionally select and implement the method of medical treatment that meets the conditions

② Article 11-4 of the Medical Care Assistance Act provides that “A medical care institution shall not request a beneficiary to pay his/her own share before providing medical care, such as medical treatment, or a beneficiary shall not claim for any other nominal expenses, such as deposit for hospitalization, in addition to the expenses to be borne by the beneficiary under this Act.” However, the aforementioned provision cannot be interpreted to the effect that the medical institution itself prohibits the patient from performing medical

③ With respect to a serious and serious disease directly connected to the life of the patient, such as a lebal disease, the medical treatment in accordance with the existing benefit criteria and permission requirements alone is, in order to seek the life of the patient and to fully treat the disease, the patient may demand the medical institution using his/her own expenses to change the medical treatment to ensure that the patient can receive medical treatment suitable for his/her own disease conditions at an appropriate time, even though it deviates from the existing benefit criteria and permission requirements. Prohibition is likely to infringe on the patient’s right to self-determination by compelling the medical institution to provide medical treatment in a normal way in accordance with the existing benefit criteria and permission requirements.

④ In a case where a medical institution, upon the patient’s request and consent, went beyond the standard of benefits or permitted matters based on the expertise as a medical person, but “medically reasonable and inevitable treatment” was conducted, such method of medical treatment may be unreasonably subject to the restriction of basic rights of medical personnel with professional qualifications to claim for beneficiaries outside the framework of the medical care system solely on the ground that it was not designated as medical care benefits or non-benefit items in the standard of benefits.

(D) Therefore, even if a medical institution prescribed and administered a drug in violation of the payment standard and permitted matters, if the medical institution satisfies all the criteria such as whether such medical institution was under extenuating circumstances, whether such medical treatment is medically feasible, and whether such medical treatment was sufficiently explained to the patient before the medical institution conducted such medical treatment, and whether prior consent was obtained from the patient in advance, it shall be deemed that the medical institution’s exemption from the aforementioned legal doctrine is recognized, and thus, it does not constitute “when it has caused the beneficiary, etc. to bear expenses for benefits” under Article 28(1)1 of the Medical Care Assistance Act, with the medical institution’s receipt of the expenses for the prescribed and dumped drug in violation of the payment standard and permitted matters.

(E) According to the facts acknowledged earlier, among the drugs that the Plaintiff hospital prescribed and administered in violation of the payment standard or the matters permitted, it can be deemed that the Plaintiff hospital prescribed and administered the treatment that is not directly related to the life and body of the patients suffering from blood diseases, such as white blood, etc. among the drugs that the Plaintiff hospital prescribed and administered in violation of the payment standard or the matters permitted. Moreover, the Plaintiff hospital’s method of prescribing and dumping at least nine of the drugs falling under the above type after the Defendant’s on-site investigation with respect to the Plaintiff hospital was not recognized medical feasibility. As such, some of the above types can be deemed to constitute “when the Plaintiff hospital made the beneficiary, etc. bear the expenses for benefits by fraud or other improper means.”

However, the following facts are acknowledged based on the above facts and evidence. ① most of the drugs that the Plaintiff hospital prescribed and administered in violation of the payment standards or the permitted matters are deemed to have been administered only in cases of determining that it is necessary to prevent additional infections caused by immunodeficiency disease of the patient during the long-term treatment process for the patients suffering from the disease, such as infertility, and to seek the patient’s life and health. ② Changes in the payment standards and permitted matters concerning ten drugs among the above types were made in accordance with the method prescribed and administered by the Plaintiff hospital, and some changes were made to the four drugs. At least 14 medical treatment methods were determined at the time of the above change, it is difficult to view that there is medical feasibility even if the Plaintiff hospital did not obtain the consent of the Plaintiff hospital because it failed to obtain the aforementioned pre-determination standards or the permitted matters, ③ the Plaintiff hospital’s application form for medical treatment or the medical treatment expenses for which the Plaintiff hospital did not obtain the consent of the patient in violation of the aforementioned treatment standards and the medical treatment expenses for which the Plaintiff hospital did not obtain the consent of the patient.

(2) The separate cost-sharing type

(A) As seen earlier, if the above type satisfies all the criteria, such as whether a medical treatment act has an inevitable reason to have been used naturally, whether the use of such a medical treatment material, equipment, etc. can be recognized as medical feasibility and cost effectiveness, whether the use of such a medical treatment material, etc., can be separately claimed from the patient even if it is not separately calculated before the use of such material, equipment, etc., and whether prior consent was obtained from the patient in advance, it shall be deemed that the above type does not constitute “when the beneficiary, etc. was charged with expenses for benefits by fraud or other improper means” under Article 28(1)1 of the Medical Care Assistance Act, recognizing exceptions to the above legal doctrine.

(B) According to the above facts, among those materials used for medical treatment for which the Plaintiff hospital’s separate calculation is unnecessary, among those materials for which the Plaintiff hospital received from the patient, it can be deemed that those materials for medical treatment are prescribed and administered in a treatment act that is not directly connected with the life of the patients suffering from blood disease, such as white transfusion, and that those materials for medical treatment such as the Plaintiff hospital’s MFS 11G 10,13G 10,13G 100 and 103(SG 144m and 24m.) are not considered to be reasonable, since those materials for medical treatment such as SNIP FIXD MPUS, and those materials for medical treatment fall under the category of “the above types of expenses for medical treatment” and “the above types of expenses for medical treatment are not considered to be reasonable.”

However, the following facts are acknowledged by the aforementioned evidence. ① In the case of an aggregate 4,00, the number of such diseases is determined as KRW 31,040 on the premise that the patient's treatment equipment would be used multiple times. As such, the increase in the number of diseases caused by a multi-use hospital to be infected, and the patient's additional infection is likely to increase even at the time of treatment. As such, the patient's hospital's treatment equipment for the treatment of the patient increased by the number of patients without the above infection and the patient's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment's treatment equipment' 1, etc.

(3) Type of claim that exceeds the standard amount

In light of the facts acknowledged earlier and the following circumstances, i.e., medical treatment belonging to the above type, i.e., medical treatment conducted within the scope not exceeding the payment standard, there is no evidence to deem that the medical validity was recognized later, ii) the expenses for the acts conducted within the scope not exceeding the payment standard among the above types of medical treatment are only partially claimed to the patient as the benefit recipient, and the remainder is claimed to the Mayor, etc., and in any case the medical institution can not immediately claim the patient with the full amount of the expenses. ③ The Plaintiff hospital is anticipated to reduce the medical expenses incurred by the Plaintiff hospital or other medical care institution in the process of examining the medical expenses of the previous Health Insurance Review and Assessment Service, and received the expenses paid from the Mayor, etc. by the patient with the full amount of the expenses to be paid by the Plaintiff hospital or other medical care institution, etc., the Plaintiff’s act in the above type constitutes “when the Plaintiff provided the benefit costs to the beneficiary, etc. by fraud or other improper means.” Therefore, this part of the Plaintiff

(4) Type of unfair claims for selective medical fees

(A) According to the rules on selective medical examination and treatment, the head of a medical institution shall comply with the request of a patient for selective medical examination and treatment by selecting a specific doctor and applying for such selective medical examination and treatment, barring any special circumstance. The head of a medical institution designates a doctor in charge of selective medical examination and treating him/her as a doctor in charge of selective medical examination and treatment within a maximum of 80% of his/her employed physician, and may collect additional expenses for selective medical examination and treatment from the patient. Furthermore, the head of a medical institution may calculate additional expenses for each selective medical examination and treatment by specifying specific items of selective medical examination, medical examination, examination, image diagnosis, and radiation treatment, anesthesia, mental therapy, treatment, surgery, skin, etc. as specific items of selective medical examination and treatment. Furthermore, the rules on selective medical examination and treatment provide a form of selective medical examination and treatment in which the patient requesting selective medical examination and treatment specifies the name of the doctor in charge of selective medical examination and treatment in the manner of specifying the name of the doctor in charge of selective medical examination and treatment.

(B) The above facts and the following facts are: ① The Plaintiff hospital did not violate the rules on selective medical treatment because the form of selective medical treatment applied used by the Plaintiff hospital is not capable of choosing a doctor in charge of the patient’s medical treatment support; ② there is no specific provision prohibiting patients from entrusting the main physician with matters concerning selective medical treatment in accordance with the existing rules on selective medical treatment; and ② there is no provision stipulating that patients may entrust the main physician with matters concerning selective medical treatment in the form of selective medical treatment application form with matters concerning selective medical treatment support and selective medical treatment (as the rules on selective medical treatment were amended to Ordinance No. 78 of the Ministry of Health, Welfare and Family Affairs on November 28, 2008, the Plaintiff hospital provided that the main physician and the doctor may delegate the selective medical treatment application form to the patient in charge of the patient’s selective medical treatment at the time of its amendment to the rules on selective medical treatment, and thus, the Plaintiff hospital may also entrust the patient and the main physician in charge of selective medical treatment with the patient’s selective medical treatment examination and treatment procedure at the time of its determination.

(5) Sub-decisions (Scope of revocation)

Therefore, as seen earlier, the instant disposition is unlawful on the following grounds: ① the type of claim for medical expenses in violation of benefit standards and permitted matters; ② the case where the Plaintiff hospital uniformly held that the Plaintiff hospital’s payment of expenses for selective medical expenses to beneficiaries, etc. by means of continuous or other unjust methods; ③ the case where selective medical fees cannot be viewed as an unjust claim; and the case where the evidence presented by the Plaintiff hospital cannot be calculated in detail on the basis of the evidence submitted by the Plaintiff hospital or the court’s examination of evidence; and as a result, the amount of reasonable penalty surcharge cannot be calculated accurately; thus, the entire disposition of this case is revoked.

3. Conclusion

Then, the plaintiff's claim of this case is justified, and accepted.

[Attachment Form 5]

Judges Kim Jong-soo (Presiding Judge)