In a case where Party A, who operates a maternity hospital, claimed hospitalization fees for a newborn baby at the hospital of a newborn baby and claimed hospitalization fees for the newborn baby and thus, the Minister of Health and Welfare imposes a penalty surcharge on the ground that it violated the standards for calculating hospitalization fees, the case affirming the judgment below holding that the hospitalization time at least 12 hours a day should be at least 12 hours a day in order to claim hospitalization fees for the hospital of a mother and child, and claiming hospitalization fees for the deficient hospitalization date constitutes an unfair claim under Article 85 of the former National Health Insurance Act.

Articles 85(1)1 (see current Article 98(1)1) and 85-2(1) (see current Article 99(1)) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201);

Plaintiff 1 and one other (Law Firm Sejong, Attorneys Gyeong-chul et al., Counsel for the plaintiff-appellant)

The Minister of Health and Welfare (Attorney Jeong Jong-chul et al., Counsel for the defendant-appellant)

Seoul High Court Decision 2012Nu33029 decided May 7, 2013

All appeals are dismissed. The costs of appeal are assessed against the plaintiffs.

The grounds of appeal are examined.

According to the records, the "health insurance medical care benefit act and its relative value points" as prescribed by the notification of the Ministry of Health and Welfare shall be determined as medical care benefit costs by calculating the admission fee for the mother and child room (mother and child room) more than the admission fee for the newborn baby in a medical institution of a member's level and by calculating the relative value point of about 50% higher than the admission fee for the newborn baby's room, but there is no clear standard as to whether the above premium rate is applied only when the newborn baby and baby are in the same hospital for more than a number of

However, according to the reasoning and evidence of the lower judgment, the system of the mother and child room corresponds to the method of hospitalization of the mother and child room in which the mother and child are different after delivery. The purpose of the system is to ensure family-centered nursing is to enable the mother and child to always contact and care for the newborn baby from the date immediately after delivery of the child, and the standard of recognition for the hospitalization of the mother and child room was not enacted and published in the form of law. However, since 197, the administrative interpretation of the Ministry of Health and Welfare has operated “where the mother and child is managed in the mother and child room for the rest of the baby's body, etc., bath of the baby's body, etc., and prevention of infection of the newborn baby, at least 12 hours” in the form of the administrative interpretation of the Ministry of Health and Welfare since 1997, it has been operated as the standard of admission fee. The fact that international organizations such as the World Health Organization recommend that the mother and the newborn baby within 24 hours a day are in the form of the mother and child room.

In light of the purport of the system of hospitalization in the mother and child ward room, the rate of admission fees for medical care benefits, and the reasoning that is the basis of interpretation of the statutes, the Defendant’s disposition of this case is justified in considering that the time of hospitalization in the mother and child ward room should be at least 12 hours per day (in the case of hospitalization that does not reach one day, half of the time of hospitalization) at least 12 hours per day, and that the Defendant’s claim for medical care benefits costs based on the premium rate for the shortage of hospitalization days constitutes an unfair claim under Article 85 of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201; hereinafter the same) and thus, it is reasonable in that it constitutes an unfair claim under Article 85 of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201). Accordingly, it is consistent with the conclusion of the judgment of the court below.

Therefore, all appeals are dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Chang-suk (Presiding Justice)