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(영문) 서울행정법원 2017.08.10 2016구합65978

장기요양급여비용환수처분취소

Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff, on the fifth and fourth floor of the building located in C, operates the “C Care Center”, which is a long-term care institution under the Act on Long-Term Care Insurance for the Aged (hereinafter “instant medical care center”), and the “Dvalescent Hospital”, which is a medical institution, on the 2-4th and fourth floor of the said building (hereinafter “instant convalescent hospital”).

B. From March 14, 2016 to the 18th day of the same month in cooperation with the National Health Insurance Corporation (hereinafter “instant on-site investigation”). As a result, the Plaintiff received the cost of long-term care benefits at KRW 93,264,560 by unfairly claiming the cost of long-term care benefits as follows.

(hereinafter “instant disposition grounds”) was determined as follows.

1. Violation of standards for placement of human resources;

A. A social worker E, who violates the criteria for placement of human resources of social workers, was absent from work in the instant convalescent hospital for at least two to four hours a day in the instant convalescent hospital from September 2015 to November, 201, and was absent from work and failed to meet the monthly standard working hours from December 22, 2015 to December 30, 2015, but did not request reduction of the amount.

(b) From July 2014 to January 2016; G from August 2014 to December 12, 2014; H from September 2014 to December 2015; and I, from November 2015 to January 2016, from November 2015, from November 2015 to January 2016, no request for reduction of amount is made, even though C, who is a caregiver of the instant medical care center, fails to work at the instant medical care center or fails to meet the monthly standard working hours on duty at night or on the day.

2. 2,285,360 won due to a failure to file an application for reduction of the prescribed number of personnel even though the J, who is the person other than the grade of violation of the prescribed number of personnel, lives at the medical care center of this case from March 13, 2015 to the 30th of the same month;

3. In the event that a person admitted to a stuffed institution was staying for gambling from January 1, 2015 to the next day, K was to be admitted to the stuffed institution, but the person was to be admitted to the stuffed institution’s expenses per day, not to be admitted to the stuffed institution.