요양급여비용환수결정처분취소
1. The Defendant’s disposition of restitution of KRW 159,387,160 for medical care benefit costs against the Plaintiffs on October 19, 2011, 92,413.
1. Details of the disposition;
A. The Plaintiffs are doctors who establish and operate D Council Members in Ansan-si C (hereinafter “instant Council Members”).
B. As the standards and methods for applying medical care benefits, which are notified by the Ministry of Health and Welfare, were amended by Act No. 2005-101 on Dec. 30, 2005, the operation of a gold-free operation began to be subject to medical care benefits. Accordingly, a situation where the health insurance finance becomes worse occurs, the Minister of Health and Welfare revised the above notification as of January 23, 2007, as follows, to prevent the spread of reckless gold-free operations and to promote the efficiency of the health insurance finance.
(2) In addition to the above criteria, the treatment fees and materials for medical treatment should be borne by the patient on the ground that the treatment fees and materials for medical treatment should be borne by the patient on the ground that the treatment fees and materials for medical treatment are less than 120 cmH200, as a result of the epidemology test (the measurement of luminous pressure and the examination of leakage pressure), and that the treatment fees and materials for medical treatment should be borne by the patient on the ground that the treatment fees and materials for medical treatment are less than 120 cmH200,000, and the treatment fees and materials for medical treatment are more than 120 cmH20,000,000 won.
The Health Insurance Review and Assessment Service (hereinafter referred to as the "Review and Assessment Service") established the following review guidelines with respect to the methods of measuring luminous pressure and leakage pressure on November 27, 2008, for the purpose of preventing in-depth test results and inducing them to provide appropriate medical treatment due to the occurrence of inaccurate test results and unnecessary surgery due to the occurrence of such test results.
(hereinafter referred to as the "examination guidelines of this case"). The method of inspection shall be conducted at the time of measuring the indoor pressure and leakage pressure.