The lower court determined that the Health Insurance Review Institute exceeded the adequate number of days of hospitalization.

The judgment below held that a crime of fraud is established against hospitalization. However, although the hospital hospitalized the Defendants at the time of hospitalization in accordance with the determination of hospitalization by the hospital medical staff who provided the Defendants at the time of hospitalization, the Health Insurance Review and Evaluation Institute decided that the claim for medical care benefits of the above hospital was not problematic, and the Health Insurance Corporation paid medical care benefits after determining that the claim for medical care benefits of the above hospital was not problematic. Thus, the Health Insurance Review and Evaluation Institute, which determined ex post facto that the document evaluation conducted at the request of an investigation agency

A. Hospitalization of the relevant legal doctrine refers to where a continuous observation by a medical personnel is required in relation to the side effects or incidental effects of the patient’s disease which are very low resistance or that of the patient’s disease, and where the management of nutritional conditions and food in-take needs to be conducted continuously, it is necessary to administer drugs, etc., and thus, the patient’s pains rather inconvenience in treatment, such as where the patient’s condition is in a situation where the patient is unable to cope with the patient’s condition or where the patient’s risk of infection exists, etc., and the patient suffers from treatment while staying in the hospital. In accordance with the provisions of the “Detailed Matters on the Standards and Method for Applying the Medical Care Benefits”, which is the public announcement of the Ministry of Health and Welfare, the patient is being treated under the observation and management of the medical personnel

Therefore, there is a need for the above hospitalization as well as the cases where the substance of the treatment corresponds to the hospital treatment rather than the hospital treatment, based on comprehensive consideration of the patient's symptoms, diagnosis and treatment, details and circumstances, and the patient's behavior.