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1. On April 24, 2017, the Minister of Health and Welfare issued a disposition to suspend the business of an institution providing medical benefits for 93 days against the Plaintiff.
Reasons
1. Details of the disposition;
A. From June 2015, the Plaintiff is an intention to operate the “Cmary Foreign Service Council member” (hereinafter “instant Council member”) located in Gyeonggi-gu Group B from June 2015 to the present.
Before operating the instant member, the Plaintiff operated the “Dvalescent Hospital” at the same place.
B. On January 12, 2015, the Defendant Minister of Health and Welfare (hereinafter “Defendant Minister”) conducted an on-site investigation as to whether the expenses for benefits in the Dvalescent hospital are adequate (the period subject to investigation: from June 1, 2013 to April 30, 2014; and from September 1, 2014 to November 30, 2014; hereinafter “the instant on-site investigation”).
C. As a result of the instant on-site investigation, based on Article 98(1)1 of the National Health Insurance Act, Defendant Minister suspended the business of the medical care institution for the Plaintiff on April 7, 2017, based on the following grounds for disposition, and on April 7, 2017.
(hereinafter “instant medical care institution’s suspension of business”); Claim for violation of the differential calculation criteria for hospitalization fees in a convalescent: 103,902,040 won: The list of health insurance benefit costs, the list of benefit costs, and the point of relative value of benefits in a convalescent hospital of Part III; and the guidelines for calculation thereof.
4. (e);
According to the differential application of the hospitalization fee-based nursing system based on the level of nursing personnel, the grade of hospitalization fee-based nursing for the immediately preceding quarter shall be calculated according to the average number of nursing personnel (expenses of the number of nursing personnel for the patient) in the immediately preceding quarter, who are engaged in nursing service for the number of patients, and according to the standards related to differential application of the hospitalization fee in a convalescent hospital according to the level of nursing personnel prescribed in Article 2009-214 announced by the Ministry of Health and Welfare, the nursing personnel shall be recognized as nursing personnel in cases of nurses exclusively in charge of nursing service for inpatientss and assistant nurses assisting the nursing service for them. However, although the nursing service for inpatients is not exclusively in charge of nursing for inpatientss, etc., the medical care benefit cost claim shall be changed to the claim of KRW 103,902,040 for medical