업무정지등처분취소
1. The Defendant’s disposition of 93 days of business suspension rendered to the Plaintiff on December 18, 2015 is revoked.
2. The costs of the lawsuit are assessed against the defendant.
1. Details of the disposition;
A. The Plaintiff, as a doctor, is operating a medical care institution, which is a medical institution, under the name of “B Council member” (hereinafter “B Council member”).
B. During the period from May 14, 2014 to September 30, 2011, the Defendant conducted on-site investigations during the period from May 1, 2011 to September 31, 201, and from January 1, 2014 to March 31, 2014.
Based on the results of the above on-site investigation, on December 18, 2015, based on Article 98(1)1 of the National Health Insurance Act, the Defendant rendered a disposition ordering the Plaintiff to suspend the Plaintiff’s business for 93 days (hereinafter “instant disposition”).
The reason for the instant disposition was that although the Plaintiff conducted medical treatment related to beauty art (i.e., improvement of appearance) subject to non-benefit under Article 9(1) and attached Table 2 of the Regulations on the Standards for Medical Care Benefits in National Health Insurance and collected the expenses from the winners of the expenses, the Plaintiff received KRW 1,151,620 in total by recording medical examination fees, etc. in the medical records and claiming medical care fees, etc. as medical care benefit costs. In this regard, the Plaintiff issued medical care benefits and charged the insurer, etc. with a total of KRW 1,913,070 (the sum of the amounts as above, but this is the amount discarded in the course of treating the end water) in an unjust manner.
Specific details of the Defendant’s calculation of the number of days of business suspension as 93 days are as follows:
(units) 7,438,830 1,913,070 239,1333 25.7193 / [based on recognition] of absence of dispute during the period of suspension of business of average of the total amount of costs of health care benefit determined during the period subject to investigation, the entries in Gap evidence 1 and 2, and the purport of the whole pleadings.
2. Whether the instant disposition is lawful
A. The Plaintiff’s assertion 1 is based on the instant disposition.