요양급여비용 환수처분취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. The instant disposition B and C, even though they are not medical personnel, opened the “E Hospital” (hereinafter “instant hospital”) in the building located in Incheon Reinforcement-gun D (hereinafter “instant hospital”) under the name of the Plaintiff, a doctor on November 4, 2010, and operated the instant hospital from that time until June 14, 2011.
The Plaintiff was employed by B and C from November 4, 2010 to June 14, 2011, and performed medical practice at the instant hospital, and was paid KRW 679,487,580 for the said period as the title holder of the instant hospital.
On October 29, 2014, the Defendant issued a disposition to recover KRW 679,487,580 from the Plaintiff based on Article 57 of the National Health Insurance Act.
(hereinafter “Disposition in this case”). 【No dispute exists, Gap evidence Nos. 2, 3, and 4, Eul evidence Nos. 1-10, the purport of the whole pleadings.
2. Whether the disposition is lawful;
A. The Plaintiff’s instant disposition is unlawful for the following reasons.
(1) Article 57(2) of the National Health Insurance Act provides that only the unjust enrichment that occurred after May 22, 2013, the enforcement date of which was the enforcement date, may be applied. As such, the foregoing provision cannot apply to the period from November 4, 2010 to June 14, 201, which is the subject period of the instant disposition.
(2) In short of the requirements for recovery disposition, the Plaintiff cannot be deemed to have violated the Medical Service Act by lending a license since it actually continued medical practice at the instant hospital and served as the president. If the instant hospital is not a medical institution lawfully established under the Medical Service Act, it cannot be subject to recovery disposition under Article 57(2) of the National Health Insurance Act, and the requirements for recovery disposition were not satisfied.
(3) The Plaintiff, who abused discretion, actually treated patients while lodging and lodging at the instant hospital for 24 hours, and the above medical care benefit cost was actually received by B and C, who is the actual operator of the instant hospital, and the Plaintiff acquired only 42 million won benefits from B and C (=6 million won x 7 months), and the Plaintiff.