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(영문) 서울행정법원 2018.08.30 2017구합82123
업무정지등처분취소
Text

1. On December 14, 2017, the Minister of Health and Welfare published the list of health insurance claims medical care institutions for the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is a doctor who operates C’s medical care institutions under the National Health Insurance Act (hereinafter “instant member”) on the level B and 2 of Mapo-si.

B. On February 2015, the Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) requested the Defendant’s Minister of Health and Welfare (hereinafter “the Minister of Health and Welfare”) to conduct on-site investigations on the current status of the instant member’s claim for health care benefit (hereinafter “on-site verification”), deeming that the Plaintiff claimed medical care benefit costs on the day of vaccination from January 201 to December 2014, and claimed for medical care benefit costs in violation of the standards for calculating the health care benefit costs for removal of foreign products from July 2014 to December 2014.

C. Around May 2016, the Defendant Minister conducted on-site investigations as to whether the instant member’s claim for medical care benefit costs is appropriate.

(Period of Investigation: from April 2013 to February 2015, and from January 2016 to March 2016; hereinafter “instant on-site investigation”). D.

On August 10, 2017, based on Article 98(1)1 of the National Health Insurance Act with respect to the Plaintiff, the Defendant Minister suspended the operation of a medical care institution for 60 days (from February 19, 2018 to April 19, 2018) with respect to the instant member, based on the following grounds for disposition:

(hereinafter referred to as “instant disposition of business suspension”. A double claim for medical care benefit after a medical treatment subject to non-payment: A vaccination subject to non-payment pursuant to Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance (2,525,010) and a local government itself shall conduct a free vaccination entrusted to a public health clinic subject to non-payment pursuant to Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance (2,525,010) and collect medical care fees from a person who has received a disease as non-payment.

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