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(영문) 서울서부지방법원 2020.02.06 2017고합345

특정경제범죄가중처벌등에관한법률위반(사기)

Text

A defendant shall be punished by imprisonment for not less than one year and six months.

However, the execution of the above punishment shall be suspended for three years from the date this judgment became final and conclusive.

Reasons

Punishment of the crime

The defendant is a person who operates the welfare equipment and medical device manufacturing headquarters B located in Manyang-gu, Manyang-si.

When a manufacturer or importer of welfare tools intends to apply long-term care benefits to older persons with welfare tools, he/she shall prepare and submit an application for determination of benefits to the president of the National Health Insurance Corporation (hereinafter referred to as the "Corporation") along with essential documents, such as cost data of the relevant welfare tools.

The Corporation shall select products subject to price consultation following the deliberation on the appropriateness, etc. of submitted documents: ① calculate the actual cost of materials, outsourcing processing cost, and imported hospitalization cost, etc. which the relevant company actually paid in creating welfare equipment and submit to the Corporation; ② “market survey price” which is the actual transaction value of the same or similar products investigated by the Corporation; ③ determine the publicly announced price based on consultation with the relevant business entity based on the lowest price among the “construction price” calculated by the Corporation based on the data on cost verification, such as tax invoices, details of transactions, and import declaration certificate submitted by the relevant business entity; and the Ministry of Health and Welfare shall publicly notify the products subject to benefits and the prices thereof as publicly

Upon receipt of a decision to pay benefits in accordance with the above procedure, the manufacturer or importer of welfare goods sells welfare goods to the place of business or agency of welfare goods (hereinafter referred to as "place of business, etc."), and the place of business, etc. sells the purchased welfare goods to the beneficiary, and then receives 85% of the notified price from the Service, and receives 15% of the remainder from the beneficiary

In filing an application for the determination of benefits, the manufacturer or importer of welfare equipment is obligated to prepare and submit the application for the determination of benefits, and submit the true cost evidence.

On the other hand, where an application is not prepared conscientiously or it is discovered that false cost evidence materials are submitted, the Corporation is notified of the lack of the results of document examination.