요양급여비용 환수처분 취소
1. The Defendant’s disposition of recovering medical care benefit costs against the Plaintiff on December 27, 2018 is revoked.
2. The costs of lawsuit shall be.
1. Details of the disposition;
A. On November 28, 2014, B, a doctor, opened a “D Council member” (hereinafter “instant Council member”) under the name of the Plaintiff, who is a doctor, in Dongjak-gu Seoul Metropolitan Government, and operated until December 6, 2016.
B. On December 27, 2018, the Defendant issued a redemption disposition (hereinafter “instant disposition”) against the Plaintiff on the ground that “The Plaintiff, the representative of the instant member, was in violation of Article 4(2) of the former Medical Service Act (amended by Act No. 14438, Dec. 20, 2016; hereinafter the same shall apply) from November 28, 2014 to December 6, 2016, on the ground that “The Plaintiff, under the investigation results of the Seoul Regional Police Agency and the details of the case of non-prosecutions of the Seoul Central District Prosecutor’s Office’s Office’s non-prosecutions, the Plaintiff, the representative of the instant member of the instant member, was confirmed to have been in violation of the foregoing provision” (hereinafter “instant disposition”).
[Ground of recognition] Unsatisfy, Gap evidence Nos. 1 and 3, the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. The summary of the Plaintiff’s assertion does not constitute “the case where the medical care institution, which is a medical institution established in violation of Article 4(2) of the former Medical Service Act, provided medical care benefits and received the medical care benefits to the Defendant after claiming the medical care benefits.” Therefore, the instant disposition is unlawful on the grounds that it does not constitute “the case where the medical care benefits are paid by means of continuous
B. The relevant statutes are as stated in the relevant statutes.
C. 1) The National Health Insurance Act was enacted for the purpose of contributing to the improvement of national health and the promotion of social security by providing citizens with insurance benefits for the prevention, diagnosis, and medical treatment of, and rehabilitation from, diseases and injuries, for childbirth and death, and for the improvement of health (Article 1). As to diseases, etc. of the insured and their dependents, the National Health Insurance Act provides health care benefits for “medical examinations, tests, medicine (pharmaceuticals), and materials for medical treatment, treatment, surgery, and other medical treatment, etc.” (Article 41(1)).