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(영문) 서울행정법원 2018.10.25 2017구합86514
요양급여비용환수처분취소
Text

1. All of the plaintiff's claims are dismissed.

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

Reasons

1. Details of each disposition;

A. On July 18, 1983, the Plaintiff, a corporation established for the purpose of the medical treatment business of local residents, etc., operated the “A medical center” (hereinafter “instant medical center”) and the “C Elderly Hospital Specializing in the Aged” (hereinafter “instant hospital specialized in the elderly”).

B. On December 2, 2016, the Commissioner of the Cheongnam-do Police Agency notified the Defendant’s president (the head of the Daejeon Regional Headquarters) of the instant medical center and the Medical Director D and the head of the management department of the instant hospital specializing in the elderly as to the following criminal facts:

D and E reported to reduce the number of beds in actual operation (average for three months) of the medical center of this case in collusion, and filed a false report on the nurses who concurrently provided nursing services to the instant medical center and the inpatients in the instant specialized hospital for the aged while working in the six-month ward of the instant specialized hospital for the aged and filed a false report with the nurse in exclusive charge of the in-patient nursing services at the general hospital of the instant medical center or the middle-patient's clinic, thereby operating the nursing class and claiming excessive medical expenses.

C. From December 8, 2016 to the 10th of the same month, the Minister of Health and Welfare conducted an on-site investigation of the instant medical center (the period subject to investigation: from October 1, 2013 to September 30, 2016; hereinafter “instant on-site investigation”) and, as a result, determined that the Plaintiff unfairly claimed medical care benefit costs as follows:

1. A claim in violation of the standards for calculation of differential rates of hospitalization (including medical benefits) based on the level of securing human resources for nursing - a differential rate of nursing management fees for in-patients based on the level of securing human resources for nursing shall be calculated according to the average number of nurses employed in nursing services at the relevant ward compared to the average number of beds for the preceding quarter immediately preceding the consent of a general sick person, and the beds for general sick persons shall be calculated based on the total number of sickbeds for medical care institutions;

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