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(영문) 서울행정법원 2016.10.13 2016구합1653

장기요양급여비용환수결정처분취소

Text

1. The plaintiff's claim is dismissed.

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

Reasons

The details and details of the disposition are as follows: (a) a long-term care institution (long-term care communal home for older persons) that provides facility benefits among long-term care benefits in the name of Kimpo-si B and 201 Dong 103.

(hereinafter “instant medical care center.” From March 3, 2015 to March 6, 2015, the Defendant and Kimpo-po-si: (a) conducted on-site investigations of the details of long-term care benefits of the instant medical care center from November 2013 to January 6, 2015; and (b) based on the premise that “D (the assistant nurse) served for less than 160 hours a month from November 2013 to November 2014, the Plaintiff was paid expenses for long-term care benefits.”

On March 31, 2015, pursuant to Article 43 of the former Act on Long-Term Care Insurance for the Aged (amended by Act No. 13647, Dec. 29, 2015; hereinafter the same), the Defendant notified the Plaintiff that “The Defendant shall recover KRW 14,69,670 (the total amount of expenses for long-term care benefits paid excessively due to the Plaintiff’s unfair claim (the violation of standards for placement of human resources of KRW 8,542,130, KRW 6,127,540).”

(hereinafter referred to as the “instant disposition”). [The grounds for recognition] did not dispute, the entries of Gap 1, 2, and 3, and the purport of the whole pleadings, the gist of the plaintiff’s assertion E ( nursing assistant) served as an assistant nurse from “F,” which is another long-term care institution operated by the plaintiff, as an assistant nurse, and worked as an part-time nurse at the instant medical care center. The working hours were at least 100 hours a month

Since the working hours of E and D are more than 160 hours a month if they combine with the working hours, one assistant nurse will have worked for an hour equivalent to one assistant nurse.

Since the Plaintiff satisfied the criteria for placement of human resources as above, the Plaintiff did not make a false claim.

Nevertheless, the instant disposition that was otherwise determined is unlawful.

Judgment

For the following reasons, the instant disposition is lawful.

It is as shown in the attached Form of the relevant statutes.

The disposition of this case.