(분리)사기
209 Highest 6428-1 (Separation) Fraudulent
ThisA (65 years old, women)
Jeon Jong-Un
Attorney Kim Young-young
March 23, 2010
A defendant shall be punished by imprisonment for not less than one year and six months.
Seized evidence 2 through 5 shall be confiscated, respectively.
Criminal facts
피고인은 1991. 3. 13. 의사 면허를 취득한 의사로서 ① 2008. 5. 7.경부터 부산 부산 진구 부전동 ○에 있는 건물 2층에서 의사 이C 명의로 ◇ 의원을 개설하여 직접 진료하고 있고, ② 2008.10. 중순경부터 부산 사상구 학장동 ○에 있는 건물 3층에서 관리의사 이C1 명의로 ◆ 의원을 개설하여 이C2를 임시 원무과장으로 근무하게 하고, ③ 2009. 4. 28.경부터 2009. 7. 30.경까지 부산 사상구 학장동 ○에 있는 건물 2층에서 □ 명의로 ■ 의원을 개설하여 의사 김C3과 최C4를 관리의사로, 이C5를 원무과장으로 근무하게 하였다.
In addition, thisC5 had been employed by the defendant from April 28, 2009 to July 30, 2009, and worked as the chief of the prime office at the above member.
피고인과 이C5는 위 ◆ 의원의 비만관리실 상담실장인 변C6, A 주식회사의 보험설계사인 김C7과 김C8 등을 환자모집인으로 고용한 후 그들을 통해 소개받은 환자들로 하여금 그들이 마치 질병으로 수술하거나 또는 입원한 것처럼 가장하여 피고인과 이C5는 건강보험관리공단으로부터 요양급여를, 환자들은 그들이 가입한 민간 보험사로부터 보험금을 지급받기로 공모하였다.
1. Fraud of the National Health Insurance Corporation (the fraud of medical care benefits directly paid to hospitals);
Around April 2009, the Defendant: (a) around April 28, 2009, at a member of the above investigation agency, issued a false medical certificate or a false confirmation of entry or discharge from the hospital that the patients were suffering from the disease; (b) submitted such documents to the Health Insurance Corporation; and (c) submitted them to receive the remainder of the medical expenses less than the patient charges as medical care benefits; and (d) then, this C2 introduced this C5 to the above investigation agency as a patient; and (c) around May 28, 2009, this C5 introduced the Da5 as a patient. From April 28, 2009 to May 28, 2009, the Defendant received the payment of the medical care benefits from the Health Insurance Corporation under the name of the Health Insurance Corporation by claiming the payment of the health care benefits under the name of the Health Insurance Corporation from around 608, 2009, by deeming that the maximum C4 of the member’s management will of the above c9 to be hospitalized from the above member.
피고인은 이를 비롯하여 이C5, 이C2, 김C7, 김C9 등 환자들과 공모 또는 순차 공모하여 2008. 11. 2.경부터 2009. 8. 21.경까지 위 의원, ◆ 의원, ■ 의원에서 별지 범죄일람표(생략)에 기재된 것과 같이 수술 또는 입원을 가장하여 건강보험관리공단의 전산시스템을 통해 요양급여의 지급을 청구하여 이에 속은 건강보험관리공단으로부터 요양급여 명목으로 총 109회에 걸쳐 합계 51,660,730원을 지급받았다.
2. Fraud of a private insurance company, such as a △△ stock company, etc. (cashation of insurance money directly paid to a patient);
Around April 2009, the defendant issued a false medical certificate or a false certificate of entrance and discharge from a hospital to the above investigation agency around 2009 at the above investigation agency: (a) around April 28, 2009, the defendant prepared a false medical certificate or a false certificate of entrance and discharge from a hospital as if the patient was in operation or hospitalized; (b) issued the documents to the patient and let him/her submit them to the insurance company to which he/she joined; and (c) our hospital ordered the above investigation agency to the effect that "any defect in receiving money from the patient" is "any defect in receiving money from the patient"; (d) this C2 introduced this C5 to the above investigation agency as a patient; and (e) this C5 introduced this C5 to the above investigation agency around May 28, 2009, the defendant received a false medical certificate from the above investigation agency around 209 to May 28, 2009 to the above △△△△△△△△, etc., and received the medical insurance money from the company from 970.
피고인은 이를 비롯하여 이C5, 이C2, 김C7, 김C9 등 환자들과 공모 또는 순차 공모하여 2009.1.14.경부터 2009.9.23.경까지 위 ◇ 의원, ◆ 의원, ■ 의원에서 별지 범죄일람표(생략)에 기재된 것과 같이 수술 또는 입원을 가장하여 환자들로 하여금 스 주식회사 등에 보험금의 지급을 청구하도록 하여 이에 속은 △ 주식회사 등으로부터 보험금 명목으로 총 58회에 걸쳐 합계 154,573,335원을 지급받았다.
Summary of Evidence
1. Partial statement of the defendant;
1. The legal statement of the witness in thisC5;
1. A protocol concerning the examination of the suspect by the prosecution against the defendant, the c5, and the C2;
1. A copy of each police examination report against Kim C7, Kim Da8, Shin Da10, Lee Da11, Kim Da12, Lee Da2, Kim C13, Lee C14, Lee C15, Kim C16, Kim C6, RedC17, and Lee C1;
1. A copy of each police statement of each police officer concerning highC18, highest C4, Kim c19, sphere C20, highest C21, light C22, Kim C23, Kim C23, Changes C24, Kim C25, and HC26;
1. A copy of each statement of Kim C19, sphere C20, Kim 28, Kim c28, Kim 37, Kim 36, Kim 38, Red C17, thisC11, Kim C12, Lee C2, Kim C13, Hac14, Hac15, Mac16, and Mac1
1. A fact-finding certificate referred to in the C27;
1. Each protocol of seizure;
1. Report, inspection place, claim for accident insurance money, medical record keeping plan, copy of insurance terms and conditions, business registration certificate, medical institution establishment report certificate, real estate lease contract, standard contents of examination (detailed details), inquiry into the details of medical examination and treatment of the Health Insurance Review and Assessment Service, copy of passbook, medical record, diagnosis document, etc., false UDS inspection result, family relation certificate and resident registration certificate, doctor's license, statement of payment, and corporate register;
Application of Statutes
1. Article applicable to criminal facts;
Articles 347(1) and 30 of the Criminal Act
1. Aggravation for concurrent crimes;
Articles 37 (former part), 38 (1) 2, and 50 of the Criminal Act
1. Confiscation;
Article 48 (1) 1 of the Criminal Act
Judges Han Han-Gyeong