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(영문) 서울고등법원 2019.09.25 2018누71542
요양급여비용환수처분취소
Text

1. The plaintiff's appeal is dismissed.

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

Purport of claim and appeal

The first instance court.

Reasons

(b) An establishment and operation;

B. From September 8, 2016 to September 9, 2016, the president of the Health Care Review and Assessment Service conducted on-site verification of the overall status of the operation of medical resources ( human resources, facilities, differential systems, meals, etc.) with respect to the instant Medical Center (hereinafter “the primary investigation of this case”).

On November 2016, the head of the Health Insurance Review and Assessment Service requested the Ministry of Health and Welfare to conduct an on-site investigation of the medical center of this case.

C. Accordingly, on November 29, 2016, the Minister of Health and Welfare ordered the instant medical center to conduct an on-site investigation as stated below with regard to the instant order, and accordingly, the investigating officer conducted an on-site investigation with regard to the instant medical center from December 5, 2016.

Orders of inspection shall be issued.

1. Agency subject to investigation: The Medical Center of this case;

2. The investigation period: from December 5, 2016;

3. Scope of investigation: All matters concerning the health insurance and medical benefits;

4. The period of investigation: The extension from July 2014 to June 2015, 2016; or from July 2016 to September 2016 (15-month Medical Treatment) * Where a false or unjust claim is confirmed, it shall be extended by up to three years.

5. Data to be submitted: Documents under Article 58 of the Enforcement Rule of the National Health Insurance Act, and Article 11 of the Enforcement Rule of the Medical Care Assistance Act and other related data

6. Surveyer: C officer of the Ministry of Health and Welfare, D competent officer, Health and Welfare Review and Assessment Service, E, F, G, H, I, and J National Health Insurance Corporation;

D. On December 8, 2016, when an on-site investigation is underway, the Minister of Health and Welfare again ordered an on-site investigation (the Minister of Health and Welfare demanded the Plaintiff to submit documents on the current status of human resources, etc. for the period from April 2013 to September 2013, separate from the following order of investigation). Accordingly, the investigator conducted an on-site investigation with regard to the instant medical center from that time until December 24, 2016.

A field investigation conducted by the Minister of Health and Welfare (hereinafter referred to as the "the second investigation of this case").

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