요양급여비용 환수처분 취소 청구의 소
1. Revocation of the first instance judgment.
2. The plaintiff's claim is dismissed.
3. All costs of the lawsuit shall be borne by the Plaintiff.
The reasoning of the judgment of the court of first instance, which partially accepted the part of the judgment, is the same as the ground of the judgment of the court of first instance, except for the partial contents among the grounds of the judgment of the court of first instance as follows. Thus, it shall be quoted in accordance with Article 8(2) of the
11. From 11. to 13.14.
A person shall be appointed.
D. In full view of the following facts as to whether the instant disposition was abused or abused of discretionary power, the Plaintiff’s assertion is without merit, since it cannot be deemed that the instant disposition was an abuse of discretionary power.
(1) Article 57 (1) of the former National Health Insurance Act provides, “The NHIS shall collect all or part of the amount equivalent to the insurance benefits or expenses from a person who has received the insurance benefits or a medical care institution that has received the insurance benefits costs by deceit or other unjust means,” and Article 57 (5) of the same Act provides, “Where a medical care institution receives the medical care benefits costs by deceit or other unjust means from a policyholder or dependent, the NHIS shall collect them from the relevant medical care
According to the above provision, if the medical care institution received unjust enrichment even though it cannot be paid as medical care benefit costs under the relevant Acts and subordinate statutes, it seems that the purpose of the above provision is to reinstate the medical care benefit costs.
In order to promote the soundness of the national health insurance finance and to secure operational transparency, the public interest needs to strictly control and manage health care benefit costs. If it is found that the insurance benefit or insurance benefit costs paid by the insured or the health care institution are caused by “a continuous or other unfair means”, the “total amount” of the insurance benefit or insurance benefit costs is subject to restitution as unjust enrichment.