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(영문) 서울행정법원 2019.06.20 2018구합74419
요양급여비용환수결정 취소의 소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Details of the disposition;

A. The Plaintiff, as a medical specialist in the regular external medicine, has established and operated the C Hospital, which is a medical care institution under the National Health Insurance Act (hereinafter “instant hospital”), in Echeon-si B.

B. On December 2, 2013, the Plaintiff registered with the Mayor of thischeon City, in order to install and operate a Computerization-to-scopic photography (hereinafter “instant CT”) which is a special medical equipment under Article 38(1) of the Medical Service Act at the instant hospital.

C. On November 8, 2017, the Defendant visited the instant hospital with an investigator in the Intelligent Criminal Investigation Team of the Seoul Metropolitan Police Agency, and confirmed the details of the claim for medical care benefit costs, etc., the Defendant determined that D/ E did not work at all at the instant hospital, which was registered as a non-exclusive film medical specialist, from April 2016 to September 2017, and did not control and supervise the instant C/T.

On July 24, 2018, the Defendant rendered a decision to recover KRW 183,972,890 for medical care benefit costs pursuant to Article 57 of the National Health Insurance Act on July 24, 2018, on the ground that the Plaintiff violated the standards for human resources to operate the Computerization-based photographing devices prescribed in Article 38(1) of the Medical Service Act and Article 3(1) [Attachment 1] of the Rules on the Establishment and Operation of Special Medical Equipment (hereinafter “instant Rules”).

[Ground of recognition] Facts without dispute, Gap evidence 1, 2, Eul evidence 1, 2 and 3, the purport of the whole pleadings

2. Whether the disposition is lawful;

A. The Plaintiff’s assertion of this case is unlawful for the following reasons, and thus should be revoked.

1) The Defendant’s guidelines for operating rules on the installation and operation of special medical equipment (hereinafter “instant operating guidelines”) due to the lack of a medical specialist in the non-exclusive image department registered as the instant CT operating personnel at least once a week.

The disposition of this case was made on the ground that it violated B.

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