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(영문) 서울행정법원 2018.12.13 2016구합80175

장기요양급여비용환수처분취소 청구

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1. The Defendant’s redemption disposition of expenses for long-term care benefits amounting to KRW 22,321,790 against the Plaintiff on October 7, 2016.

Reasons

1. Details of the disposition;

A. The Plaintiff is operating the “C Welfare Center”, a long-term care institution under the Act on Long-Term Care Insurance for the Aged in Seoul Special Metropolitan City, Nowon-gu (hereinafter “instant welfare center”).

B. From June 20, 2016 to April 23, 2016, the head of Nowon-gu conducted an on-site investigation of the instant welfare center (the period subject to the investigation: May 2014 to April 2016; hereinafter “instant on-site investigation”) and the Defendant supported the investigation personnel.

As a result of the instant on-site investigation, the Defendant determined that the Plaintiff received the cost of long-term care benefits unfairly as follows.

- Unauthorized monthly services: 5,713,810 won - From May 2014 to April 2016, the average of 50% of the monthly amount of care benefits of the recipient E from May 2014 to April 2016 is against the principle of home visit care: 22,321,790 won - G caregiver's home (Seoul, Nowon-gu's home located in Gangnam-gu)'s home of the F Care Center (hereinafter referred to as "Seoul, Nowon-gu's home") to which the recipient would not provide visiting care: 10% of the total amount of care benefits paid to the recipient J, K (F Care Center affiliated with), and L (ungraded) were supplied to the recipient E in a communal life, and 10% of the total amount of care benefits paid to the recipient's home care service without unfairly receiving the cost of visit care from 15:190 to 105% of the total amount of long-term care benefits; and 25% of the amount paid to the recipient's.

C. On July 8, 2016, the Defendant issued a disposition to recover expenses for long-term care benefits to the Plaintiff based on Article 43 of the Act on Long-Term Care Insurance for the Aged (= KRW 5,713,810, KRW 22,321, KRW 790, KRW 183,90).

(hereinafter referred to as “instant disposition”) . [Grounds for recognition] dispute.