요양급여비용 지급보류처분 취소
1. The Defendant’s disposition to suspend the payment of medical care benefit costs against the Plaintiff as of November 17, 2015 is revoked.
2...
1. Details of the disposition;
A. The Plaintiff established a B convalescent hospital, which is a medical care institution under the National Health Insurance Act (hereinafter “instant hospital”), and operated until December 10, 2015, and is currently under suspension of business.
B. On November 17, 2015, the Defendant rendered a disposition to withhold the payment of medical care benefits with the following content to the Plaintiff:
(hereinafter referred to as the "disposition in this case"). The investigation results by the judicial agency are confirmed to have violated Article 33 (2) of the Medical Service Act or Article 20 (1) of the Pharmaceutical Affairs Act, and it does not constitute a medical care institution provided for in Article 42 (1) of the National Health Insurance Act. In this case, we cannot claim medical care benefit costs.
Accordingly, the Corporation notifies that it will withhold the payment of medical care benefit costs until it is confirmed that it is a medical care institution as provided by the National Health Insurance Act.
C. The Plaintiff presented a written opinion to the Defendant stating that “The instant hospital is not an office-general hospital, but an office-based hospital, which is the actual owner of the instant hospital, and the result of the investigation of the mid-term Police Station cannot be accepted since it did not have any clear suspected fact up to the present day.”
As a result of the investigation by the investigation agency, the Defendant rejected the Plaintiff’s objection on the ground that the instant hospital was confirmed to have violated Article 33(2) of the Medical Service Act, etc.
[Ground of recognition] Facts without dispute, Gap evidence Nos. 1, 2, and 5, the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. The Plaintiff’s assertion that the police investigation was not completed on the charge of violating the Medical Service Act by the Plaintiff. Therefore, it does not constitute “a case where the fact of violation of the Medical Service Act is verified as the investigation result by an investigative agency” under Article 47-2(1) of the National Health Insurance Act.
Nevertheless, the Defendant’s disposition of this case was unlawful.
(b) The details of the relevant statutes are as shown in the attached statutes.
C. Determination of the National Health Insurance Act Article 47-2.