[1] The purport of Article 13(1) of the Guarantee of Automobile Accident Compensation Act, which provides for the obligation to prepare and keep a reading check for video diagnosis

[2] The case where a medical institution's claim for medical fee covered by automobile accident insurance without preparing and keeping a statement of opinion on video diagnosis constitutes a violation of Article 11 (3) of the Guarantee of Automobile Accident Compensation Act

[3] The case reversing the judgment of conviction on the ground that if the medical records of a medical institution include a statement that there was a reading of video diagnosis, it cannot be viewed as claiming medical fees covered by automobile insurance differently from the medical records of the medical examination

[1] Article 13(1) of the Guarantee of Automobile Accident Compensation Act / [2] Articles 11(3) and 38(3) of the Guarantee of Automobile Accident Compensation Act / [3] Articles 11(3) and 38(3) of the Guarantee of Automobile Accident Compensation Act

Defendant 1 and one other

Defendants

Daegu District Court Decision 2004No3514 Decided April 20, 2006

The part of the lower judgment against Defendant 2 is reversed, and that part of the case is remanded to the Daegu District Court Panel Division. Defendant 1’s appeal is dismissed.

1. As to Defendant 2’s appeal

A. As to the part of the wrongful claim of medical fees indicated in the attached Table 2. List of Attached Table 4 and the attached Table 4. List of Attached Table of the lower judgment (hereinafter “Attachment of the lower judgment”)

Examining the evidence admitted by the court below in light of the records, it is proper that the court below found Defendant 2 guilty of the charges against the violation of the Guarantee of Automobile Accident Compensation Act, as stated in the attached Table 2. and the attached Table 4. The court below did not err by misapprehending the facts against the rules of evidence without failing to exhaust all necessary deliberations, as alleged in the grounds of appeal.

B. As to the part of the wrongful claim of medical fees as indicated in the attached Table 5.

(1) Summary of the facts charged

The summary of this part of the facts charged is that "the defendant 2 is the director of (the name of the hospital omitted) hospital, and (the name of the hospital omitted) as the secretary of the hospital, the non-indicted 2, who is the defendant 2's employee, requested 11 non-life insurance companies, including Dongbu Fire Marine Insurance Co., Ltd., Ltd., the insurer, in addition to the medical records, for the total amount of KRW 42,812,891, in addition to the medical records, without preparing a reading statement on video diagnosis from January 2, 2003 to April 10, 2004, as shown in the attached Table 5."

(2) The judgment of the court below

After compiling the adopted evidence, the court below found the facts as stated in its decision, and found the insurer to claim medical fees covered by automobile accident insurance, pursuant to the relevant provisions such as the Guarantee of Automobile Accident Compensation Act, the Standards for Motor Vehicle Insurance Medical Fees (Public Notice of the Ministry of Construction and Transportation), the Health Insurance Act, and the equivalent value points (Public Notice of the Ministry of Health and Welfare), the medical institution must prepare an application in accordance with the medical records such as medical records, and the insurer may request the medical institution to allow access to the relevant medical records or submit data. According to the above public notice of the Ministry of Health and Welfare that took effect from January 1, 203, the medical institution must prepare and keep a reading report for the claim of reading fees. Accordingly, the court below found the Defendant guilty of the portion of the reading report without considering the result that the non-indicted 1 et al. al. did not appear to have read the X-ray or CT photography by reading it in the medical records until December 31, 2002.

(3) Judgment of this Court

However, we cannot accept the above decision of the court below for the following reasons.

Article 11(3) of the Guarantee of Automobile Accident Compensation Act (hereinafter “Act”) provides that “When a medical institution claims an automobile accident insurance to an insurer, etc. pursuant to the provisions of Article 11(2) of the Act, it shall be claimed according to the medical records provided for in Article 21 of the Medical Service Act.” Article 38(3) of the Act provides that “the medical institution that claims automobile accident insurance differently from the medical records in violation of Article 11(3) of the Act shall be punished,” while the Minister of Construction and Transportation may establish and publicly notify the standards for medical fees covered by automobile accident accident accident victims and to prevent disputes between the medical institution and the insurer, etc. regarding the preparation and public notification of the standards for medical fees covered by the Act, it shall be deemed that the medical institution did not have any obligation to prepare and keep the medical records so that it can be easily prepared and kept, solely on the basis of the standards for medical examination and treatment of traffic accident patients and the extent of recognition of such medical fees, it shall be deemed that the medical institution did not have any duty to prepare and keep the medical records for examination.”

In light of the above legal principles and records, there are cases where the medical records prepared concerning the patients at issue as to the falsity of the request for the reading fee in this case read X-ray photographs or CT photographics and state their opinions, and there are cases where the reading of X-ray photographs or CT photographics can be seen as referring to the result even though there is no explicit statement as to the reading. Thus, if the medical records indicate that there was the reading of the video examination, this cannot be said to be a claim for medical fees covered by automobile accident insurance differently from the medical records.

Nevertheless, the court below found the defendant guilty of this part of the facts charged on the ground that the reading fee cannot be claimed without examining whether or not there is a statement that can be known that there was a read reading on the video diagnosis in the medical examination and the reading fee cannot be prepared and kept after January 1, 2003. Thus, the court below erred in the misapprehension of the legal principles on the violation of the Guarantee of Automobile Accident Compensation Act by failing to exhaust all necessary deliberations or by misapprehending the legal principles on the violation of the Guarantee of Automobile Accident Compensation Act by claiming medical fees, which affected the conclusion of the judgment.

C. Scope of reversal

As above, the part which the court below found Defendant 2 guilty of the unfair claim of medical fees listed in the attached Table 5 of the indictment of violation of the Guarantee of Automobile Accident Compensation Act against Defendant 2 should be reversed, and Defendant 2's appeal as to the unfair claim of medical fees listed in the attached Table 2 of the attached Table and the attached Table 4 of the attached Table is without merit, but the court below found Defendant 2 guilty of each of the above parts and sentenced Defendant 2 with only one punishment on the ground that it constitutes a single comprehensive crime. Thus, the judgment of the court below against Defendant 2 should be reversed in its entirety.

2. As to Defendant 1’s appeal

Examining the evidence admitted by the court below in light of the records, it is proper that the court below found Defendant 1 guilty of the part of the illegal claim for medical fee stated in the attached Table 2, among the facts charged in this case against Defendant 1 and the violation of the Guarantee of Automobile Accident Compensation Act, and there is no error of law by failing to exhaust all necessary deliberations and by mismisunderstanding the facts against the rules of evidence.

3. Conclusion

Therefore, the part of the lower judgment against Defendant 2 is reversed, and that part of the case is remanded to the lower court for further proceedings consistent with this Opinion. Defendant 1’s appeal is dismissed. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Yang Sung-tae (Presiding Justice)