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(영문) 대법원 1997. 8. 22. 선고 96누5711 판결

[재활및물리치료실시기관인정해지처분취소][공1997.10.1.(43),2903]

Main Issues

[1] Whether a legitimate transfer procedure should be followed when an appeal is filed against the rehabilitation and physical therapy institution's termination of the insurance benefit cost (affirmative)

[2] Whether a disposition to terminate the recognition of rehabilitation and physical care institutions for the same reason after the revocation of the designation of medical care institutions constitutes a second disciplinary measure and thus becomes invalid (negative)

Summary of Judgment

[1] A disposition to terminate the recognition of a rehabilitation and physical treatment institution shall be made in accordance with Article 35 (1) of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995) in accordance with the "the criteria for the recognition of an institution providing rehabilitation and physical treatment" among the criteria for medical insurance medical treatment fees prescribed by the public notice of the Ministry of Health and Welfare pursuant to Article 35 (1) of the same Act. The main text of Article 70 of the same Act provides that a lawsuit against the disposition of insurance benefits costs shall not be filed unless the decision of the Reexamination Committee under Article 61 of the same Act has been made. Thus, if a lawsuit against the disposition is not duly transferred due to the failure of a request for review under Article 61 of the same Act within the prescribed period upon receipt of the decision of dismissal, the lawsuit seeking cancellation of the relevant disposition is unlawful.

[2] The termination disposition of the recognition of rehabilitation and physical treatment institutions is taken in accordance with Article 35 of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995), separate from the cancellation disposition of the designation of medical care institutions under Article 33 of the same Act, and the notification of the Ministry of Health and Social Welfare based on the provisions of Article 35 of the same Act (amended by Act No. 4972 of Aug. 4, 1995), and thus, it is related to the cost of insurance benefits with the purport that, in particular, the cost of rehabilitation and physical treatment should not be paid out of the cost of insurance benefits claimed by the relevant medical care institution. Thus, the instant

[Reference Provisions]

[1] Articles 35, 60, and 70 of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995); Article 18(2)1 of the Administrative Litigation Act / [2] Articles 33 and 35 of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995)

Reference Cases

[2] Supreme Court Decision 94Nu6642 delivered on December 27, 1994 (Gong1995Sang, 702)

Plaintiff, Appellant

Plaintiff (Attorney Lee Chang-chul, Counsel for the plaintiff-appellant)

Defendant, Appellee

Medical Insurance Federation (Law Firm Bag, Attorneys Noh Jeong-eng et al., Counsel for the defendant-appellant)

Judgment of the lower court

Seoul High Court Decision 95Gu12028 delivered on March 19, 1996

Text

The appeal is dismissed. The costs of appeal are assessed against the plaintiff.

Reasons

The grounds of appeal by the plaintiff's attorney are examined (to the extent of supplement in case of supplemental appellate briefs not timely filed).

1. On the third and fourth grounds for appeal

According to the reasoning of the judgment below, the court below held that the measure of this case against the plaintiff for rehabilitation and physical treatment (hereinafter "the measure of this case") was taken pursuant to Article 60 of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995; hereinafter "the Act") and the measure of this case for the cancellation of the insurance benefits payment costs cannot be filed unless it goes through the re-examination committee's decision under Article 61 of the Act, Article 35 (1) of the former Medical Insurance Act (amended by Act No. 4972 of Aug. 4, 1995; hereinafter "the above measure of this case"). The plaintiff's ground of appeal No. 97 of the revised Act No. 97 of Dec. 15, 1989, which was enacted by Act No. 94-31 of Jul. 28, 199).

2. On the first and second grounds for appeal

The court below rejected the part of the plaintiff's claim that the disposition of this case is null and void, on the ground that the disposition of this case was made in accordance with the above Article 35 of this Act and the notification of the Ministry of Health and Social Affairs based on the above Article 35 of the Act and the above Article 33 of this Act. Since the insurance benefit expenses claimed by the medical care institution in question should not be paid for rehabilitation and physical treatment, it cannot be viewed as a disposition of this case without any legal grounds, or that the defendant made double double double sanctions with the cancellation of the designation of medical care institution in relation to the same case. The above judgment of the court below is just and acceptable (see Supreme Court Decision 94Nu642 delivered on December 27, 1994). Thus, since the legality of the administrative disposition should be determined based on the law and the fact at the time of the administrative disposition, it cannot be viewed as a defect in the pertinent disposition even if it did not make a public notification of the revised disposition of this case concerning rehabilitation and physical treatment.

3. Therefore, the appeal is dismissed and all costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Song Jin-hun (Presiding Justice)