사기
The defendant shall be innocent.
1. The facts charged in the instant case [the premise fact] from March 2, 2009 to February 6, 2015, the Defendant is the representative of “D”, which is a long-term sanatorium for older persons located in Gangnam-gu Seoul Metropolitan Government, Gangnam-gu, Seoul, to provide services to beneficiaries by employing social workers, medical care guardians, nurses, etc., and the National Health Insurance Corporation (hereinafter “Corporation”) as a package of claims for the benefits, etc. of each medical care care benefits to the victims.
The operator of a sanatorium for older persons shall place at least 30 persons who are admitted to the sanatorium for older persons, one social worker and one physical clinic for older persons, and additionally assign one nurse for more than 100 persons, and one nurse for each 25 persons admitted to the sanatorium for older persons and one physician for medical care protection for each 2.5 persons admitted to the sanatorium for older persons, respectively.
In addition, the operator of a sanatorium for older persons may claim expenses for care for older persons when he/she claims the expenses for care for employed persons, if the monthly working hours are at least 160 hours, he/she may claim 100% of the expenses for care in accordance with the guidelines for the placement of employees, and if he/she fails to meet the guidelines for the placement of employees, he/she may claim reduced expenses for care in accordance with the prescribed ratio, and if he/she additionally places an employee in comparison with the guidelines
[Criminal facts]
1. On November 2009, the Defendant entered the information system on the victim’s website by accessing the computer at the above sanatorium’s office and then entered as if he had worked normally as a physical clinic on October 2009, and then claimed additional 10% of the victim’s additional benefits to the Corporation. Around that time, the Defendant received 14,796,030 won from the Corporation as additional expenses for medical care benefits as additional expenses.
The Defendant, including this, obtained a total of KRW 174,385,790 as additional dues for medical care benefits throughout the period from November 2009 to November 201, 201, including attached Table 1.
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