The appeal is dismissed.

The grounds of appeal are examined.

Article 87(1)2 and Article 33(2) of the Medical Service Act prohibit a person who is not qualified to establish a medical institution from establishing a medical institution by limiting the qualification of a medical institution founder to a doctor, an oriental medical doctor, etc. In such a case, criminal punishment is imposed on such person. This is to strictly limit the qualification of a medical institution to a medical person with expertise in establishing a medical institution or a person with public character, thereby establishing a healthy medical order and preventing risks to national health that may arise in the event that a medical institution is established for profit-making purposes (see, e.g., Supreme Court Decision 2009Do2629, Oct. 27, 201). In addition, Article 42(1)1 of the National Health Insurance Act limits one of the medical institutions eligible to receive medical care benefits to “medical institutions established under the Medical Service Act.”

Therefore, if medical care benefits have been paid to a medical institution that was not lawfully established in violation of Article 33(2) of the Medical Service Act, such as medical care benefits, the pertinent medical institution does not constitute a medical care institution that is entitled to claim medical care benefits under the National Health Insurance Act (see, e.g., Supreme Court Decisions 2014Da229399, May 29, 2015; 2012Da72384, May 14, 2015). As above, if a medical institution established by a non-medical person is a medical care institution legally established under the Medical Service Act, claiming medical care benefits payment would cause error in the decision-making on the payment of medical care benefits, and thus, it constitutes fraud if medical care benefits have been paid from the National Health Insurance Corporation through such deception, it constitutes fraud.