요양급여비용삭감처분취소
1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
Purport of claim and appeal
The first instance court.
1. The issues of the instant case and the judgment of the court of first instance
A. The key issue of the instant case was as a result of the on-site investigation conducted by the Ministry of Health and Welfare around September 27, 2013, stating that “as a result of verifying the Plaintiff’s claim for medical care benefit costs, the Defendant claimed for food for hospitalization in an unlawful building without reporting the establishment and operation of meal service facilities under the Food Sanitation Act” was determined on October 16, 2013 and October 17, 2013 regarding meal service costs among the medical care benefit costs requested by the Plaintiff on October 16, 2013 (i.e., KRW 18,249,740 (= KRW 14,987,070 on October 16, 2013 + KRW 3,232,670 on October 17, 2013) to reduce the scope of food care benefit costs in excess of the scope of food care benefit costs and the basic food for the next patient.” The Defendant notified the Plaintiff thereof.
(hereinafter “instant disposition”). According to the criteria and methods for applying medical care benefits under Article 41 of the National Health Insurance Act, Article 21(2) of the Enforcement Decree of the National Health Insurance Act, and Article 5 [Attachment Table 1] of the Regulations on the Standards for Medical Care Benefits for National Health Insurance / Medical Care Benefits, medical care institutions provide “medical care benefits such as medical examination, supply of medicine and materials for treatment, surgery and other medical treatment, preventive rehabilitation, hospitalization, nursing, transfer, etc.,” and in particular, the meals for hospitalized patients should be provided at a level appropriate for the treatment of patients in a sanitary manner in compliance with the standards prescribed by the Medical Act and subordinate statutes and the Food Sanitation Act.
Article 8(2) and (4) of the Regulations on the Standards for Medical Care Benefits in National Health Insurance provides the patient's meals at a medical care institution equipped with the manpower and facilities standards prescribed by the Medical Service Act and the Food Sanitation Act, according to the guidelines for calculation of the patient's meals in Chapter 17 of the "the point of relative value of the expenses for the act of health insurance" publicly notified by the Minister of Health and Welfare
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(e).