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(영문) 서울행정법원 2018.08.16 2018구합52426
요양급여비용환수처분취소
Text

The Defendant’s disposition to recover medical care benefit costs rendered to the Plaintiff on December 27, 2017 is revoked.

Costs of lawsuit shall be borne by the defendant.

Reasons

1. Details and details of the disposition;

A. The Plaintiff, as a dentist, lent his name in double establishment and management of dental care institutions under the name of the Plaintiff, and provided medical care benefits and claimed expenses from the medical care institutions.

In other words, when establishing and operating a dental clinic at the Gyeongdong-gun, B, from August 19, 2014 to January 12, 2016 (hereinafter “the instant period”), established a Fental clinic (hereinafter “instant clinic”) in the name of the Plaintiff in Seoul Special Metropolitan City E, and operated it by employing the Plaintiff at the same time.

B. On December 27, 2017, the Defendant rendered a disposition to recover the above medical care benefit costs (hereinafter “instant disposition”) pursuant to Article 57(1) of the National Health Insurance Act on the ground that “The instant member was a medical institution established in violation of the standards for the establishment of a medical institution under Article 33(8) of the Medical Service Act during the instant period, and cannot be a medical care institution under the National Health Insurance Act.” The Plaintiff provided medical care benefits to the winners of the instant member and received a total of KRW 119,172,330 from the Defendant.”

[Reasons for Recognition] Unsatisfy, Gap evidence Nos. 1, 3, 6, 8-10, Eul evidence Nos. 1 and 2, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The details of the relevant statutes are as shown in the attached statutes.

B. 1) Whether the Plaintiff’s assertion of the grounds for disposition is recognized or not, in violation of Article 33(8) of the Medical Service Act, a medical institution that is a medical institution established in violation of Article 57(1) does not constitute “the case where the medical care benefit was paid in a continuous or other unlawful manner” under Article 57(1) of the National Health Insurance Act. Therefore, the instant disposition is unlawful. Accordingly, the relevant provision and legal doctrine (i.e., determination of whether it is unlawful) and (ii) (i., Article 42(

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