요양기관 업무정지처분 취소 등 청구의 소
1. The plaintiffs' claims against the defendants are all dismissed.
2. The costs of lawsuit are assessed against the plaintiffs.
B. On-site investigations as to whether a claim is filed (the period subject to investigation: from September 2012 to August 2015; hereinafter “instant on-site investigations”). D.
As a result of the instant on-site investigation, based on Article 98(1)1 of the National Health Insurance Act, Defendant Minister ordered the following disposition to suspend the operation of medical care institutions for 30 days (from May 14, 2018 to June 12, 2018) against the Plaintiffs on October 12, 2017.
(hereinafter referred to as the “instant disposition of business suspension”); (a) double claims for medical care benefit costs and unfair claims for medicine costs after non-benefit medical treatment: 107,097,970 won - 107,970 won under attached Table 2 of Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance; and (b) conduct vision correction to replace contact lensess, etc.; and (c) collect examination fees, etc. as medical care benefit costs (60,472,520 won); and (d) claim for pharmacy medication fees, etc. as medical care benefit costs even if the costs were collected to the person who received the charge as non-payment; and (e) issue an out-of-the-counter prescription subject to medical care benefit costs (46,626,431 won);
E. Specific calculation of the period of business suspension of the instant case is as follows.
The total amount of costs of health care benefit for the investigation period (from September 2012 to August 2015, 36) shall be 10,39,194,150 won 107,097,970 won 2,974,943 won 1.02% of the total amount of costs of health care benefit for the investigation period (1.02% of the average monthly amount of unfair amounts)
F. On December 7, 2017, Defendant Corporation rendered a disposition to recover medical care benefit costs of KRW 60,472,400 on the basis of “Article 57 of the National Health Insurance Act” against the Plaintiffs on the grounds of “the double claim for medical care benefit costs after treating non-benefit eligible for medical treatment.”
(hereinafter “instant restitution disposition,” and the purport of the entire pleadings and arguments as follows: (a) there is no dispute between the instant restitution disposition and the instant disposition of this case; (b) Gap evidence 1, Eul evidence 1, 2, and Eul evidence 1; and (c) the purport of the entire pleadings and arguments.
2. Whether each of the dispositions of this case is legitimate.