장기요양급여비용환수처분취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. Details of the disposition;
A. On February 12, 2013, the Plaintiff was designated as a long-term care institution that provides facility benefits pursuant to Article 31(1) of the former Long-Term Care Insurance Act (amended by Act No. 12067, Aug. 13, 2013); “B” is a person who operates a sanatorium for the aged under Article 34(1)1 of the Welfare of Older Persons Act (hereinafter “instant sanatorium”).
B. From August 25, 2014 to August 28, 2014, the Defendant and the Yangyang market jointly conducted a field investigation on the instant sanatoriums (from March 25, 2013 to June 2014; hereinafter “instant field investigation”).
C. On October 27, 2014, based on the result of the instant on-site investigation, the Defendant notified the Plaintiff of a decision to recover KRW 134,65,900 for expenses for long-term care benefits pursuant to Article 43 of the former Long-Term Care Insurance Act (amended by Act No. 13647, Dec. 29, 2015) on the grounds as follows with respect to the instant sanatorium.
(hereinafter “instant disposition”). 【Grounds for Disposition】
1. Violation of criteria for placement of human resources: 127,824,880 won - falsely registering a caregiver who has not worked as a caregiver, or registering a worker who has exclusively performed other duties, such as a cook, as a caregiver, and claiming the cost of long-term care benefits unfairly; 2. A violation of criteria for additional placement of human resources: 35,00 won - Where a violation of criteria for placement of human resources occurs, the relevant month shall be unfairly added expenses for long-term care benefits on April 3, 2013, although the additional placement of human resources is not possible; 6,361,100 won - A claim for long-term care benefits after a failure to provide services: From May 2013 to October 10, 2013; 1.14,920 won - A beneficiary, who has not been admitted, shall be admitted to the Service to receive the service for medical care, and the expenses for long-term care benefits shall be claimed unfairly on April 20, 2013;