November 28, 2019

2. The costs of appeal shall be borne by the Plaintiff.

The judgment of the first instance is revoked. The defendant's notification of the decision to recover medical care benefits on December 29, 2016 and notification of the decision to recover medical care benefits on January 25, 2017 against the plaintiff shall be revoked.

The grounds for appeal by the plaintiff are not significantly different from the allegations in the first instance court, and the fact-finding and decision of the first instance court are justified even if the parties' claims are examined in addition to the evidence submitted to the court in the first instance.

Therefore, the reasoning of the judgment of this court is as follows, except for the dismissal of part of the reasoning of the judgment of the court of first instance or addition of the judgment of the plaintiff's argument emphasized in the trial of the court of first instance, and therefore, it is identical to the reasoning of the judgment of the court of first instance. Thus, it is accepted in accordance with Article 8 (2) of the Administrative Litigation Act and the main text

2. Parts to be corrected;

From the 7th bottom to the 4th "(b)", the term "paragraph (e)" shall be read as "e.g."

The following is added from the last 8th to the first 9th 1st eth eth eth eth eth eth eth eth.

In light of the above evidence and the statements in Gap evidence (including the above evidence and the paper numbers) the plaintiff violated the requirements for human resources for nurses inevitably required to an emergency medical institution for a long time as specified in the following table, and the degree of the violation also is less vulnerable. Furthermore, even considering the circumstances asserted by the plaintiff, such as that the plaintiff was unable to meet the requirements for human resources for nurses due to the lack of emergency medical service area, the above judgment shall not be hindered.

(Omission of List)

Article 11-12 of the Emergency Medical Service Act provides that “No person shall be deemed to be an emergency medical act under the Emergency Medical Service Act and subordinate statutes” shall be deemed to be an act of emergency medical service corresponding thereto, which was scheduled to claim and pay emergency medical service management fees due to normal conduct in accordance with the Emergency Medical Service Act and subordinate statutes.”

Part 10 No. 6 of "only appears to have failed to conduct an examination" means a business system or practice that does not conduct an examination, and only changes into "emergency medical service management fees shall be paid once it is designated as an emergency medical institution (as long as it is designated as an emergency medical institution, and where it is recognized that it is a false or unreasonable claim, it is a separate issue)."

○ Part 10, paragraph 13, add to the following:

Article 57(1) of the National Health Insurance Act provides that “The requirements of Article 57(1) of the National Health Insurance Act are inconsistent with deception, causation, which is a constituent element of fraud, and the degree of proof for the recognition of the existence of a violation in the criminal litigation, and the degree of proof for the recognition of the existence of a violation are different in the criminal litigation. Thus, even if the Plaintiff was acquitted on the grounds that the said criminal judgment does not recognize deception or causation, such circumstance does not conflict with the above judgment that the Plaintiff constitutes “in the event that the Plaintiff received insurance benefit costs by fraud or other improper means” as a recovery ground under Article 57(1) of the National Health Insurance Act, it is not inconsistent with or incompatible with the above judgment that the Plaintiff constitutes “in the event that the Plaintiff received the insurance benefit costs by fraud or other improper means.”

3. Additional determination

A. The plaintiff's assertion

1) Emergency medical service management fees paid pursuant to the Emergency Medical Service Act, etc. do not satisfy the requirements for designation of local emergency medical institutions under the regulations, and it is reasonable to view that emergency medical service management fees may be paid even if local emergency medical institutions such as nursing personnel do not meet the requirements for designation as long as emergency medical institutions actually take place. Furthermore, the portion in which the Plaintiff falsely prepares a nursing workforce report is only the requirements necessary for receiving subsidies from emergency medical institutions, and there is no causal relationship with receiving emergency medical service management fees. Therefore, it cannot be deemed that the Plaintiff’s payment of emergency medical service management fees

2) Total recovery amount of KRW 171,894,060 based on the instant disposition (i.e., emergency medical management fees of KRW 137,515,248 paid by the Defendant Corporation + Emergency medical management fees of KRW 34,378,812 that the Plaintiff did not receive, or was unlawful due to a mistake in the calculation of specific amount.

B. Legal principles

Article 57(1) of the National Health Insurance Act provides that "the Corporation shall collect all or part of the amount equivalent to the expenses for insurance benefits or insurance benefits from a person who has received insurance benefits or a medical care institution who has received insurance benefits by deceit or other unjust means," and "the expenses for insurance benefits" does not require the medical care institution to submit false data or actively conceal facts in order to receive the medical care benefits, but includes all the acts of receiving the medical care benefits by claiming them even though they cannot be paid as the medical care benefits in accordance with the relevant Acts and subordinate statutes (see Supreme Court Decision 2008Du3975, Jul. 10, 2008). Further, medical care benefits provided for in each subparagraph of Article 41(1) of the National Health Insurance Act should be conducted at a medical care institution provided for in Article 42 of the same Act, and it is natural on the premise that the medical care benefits are performed by meeting qualifications, requirements, etc. in accordance with the relevant provisions, such as the Medical Service Act, etc. (see Supreme Court Decision 2004Du5874, Sept. 24, 2004).

C. Determination

1) In light of the aforementioned legal principles, in order for a medical care institution to receive emergency medical care fees pursuant to Article 23(1) of the Emergency Medical Service Act and the delegation thereof, an emergency medical care institution under Article 2 subparag. 5 of the Emergency Medical Service Act should be a case where emergency medical treatment and first aid have been performed at an emergency medical institution under its authority. Such an emergency medical treatment act is required to be lawfully conducted in a state that satisfies human and physical requirements prescribed by the Emergency Medical Service Act and subordinate statutes. The Plaintiff committed an emergency medical service in an unlawful state during which a local emergency medical institution failed to meet the human resources requirements for nurses under the Emergency Medical Service Act, and that this would be contrary to the legislative intent of the Emergency Medical Service Act. However, if the Plaintiff received an emergency medical care management fees despite such an emergency medical act was unable to receive the emergency medical care fees, it should be deemed that such act constitutes “influence or other unfair methods” under Article 57(1) of

In addition, the purpose of the disposition to recover medical care benefit costs under Article 57 (1) of the National Health Insurance Act is to strictly control and manage medical care benefit costs in order to promote the soundness of national health insurance finance and secure transparency in its operation. The disposition to collect unjust enrichment based on the above provision is different in nature from the return of unjust enrichment under civil law, and thus, it is a disposition to reinstate if it is paid even though it cannot be paid as medical care benefit costs under the relevant laws and regulations. Therefore, even if an emergency medical service is actually provided, if it fails to meet the qualifications as an emergency medical service act, such as human and physical requirements, etc., as provided by the

2) According to the evidence mentioned above and the evidence stated in Eul evidence Nos. 13, the amount to be recovered from the instant disposition is only KRW 170,346,570 (i.e., Disposition 62,638,980, Dec. 29, 2016 + Disposition 107,707,590, Jan. 25, 2017) and is not KRW 171,894,060, as otherwise asserted by the plaintiff, but is not KRW 171,894,060.

3) Therefore, the Plaintiff’s above assertion is without merit.

4. Conclusion

Therefore, the plaintiff's claim shall be dismissed as it is without merit. The judgment of the court of first instance is just and the plaintiff's appeal is dismissed as it is without merit. It is so decided as per Disposition.

Judges Goeopop (Presiding Judge)