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(영문) 서울행정법원 2019.01.17 2017구합73433
과징금 부과처분 취소
Text

1. The plaintiff's claims against the defendants are all dismissed.

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

Reasons

1. Details of each disposition;

A. The Plaintiff, as a doctor from February 21, 2006, established and operated a “Csan medical care institution” (hereinafter “instant member”), which is a health care institution under the National Health Insurance Act, in Namyang-si, Namyang-si.

B. On January 22, 2014, the Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) received a report from the Defendant Corporation on the following: (a) the instant Council member was recommended to conduct a health examination, which was free of charge from the Plaintiff, and was exempt from personal charges (limited to the required field examination, hereinafter “the required field examination”); and (b) the Plaintiff became aware of the claim for health care benefit from the Defendant Corporation by reporting a detailed statement of medical expenses.

After conducting on-site verification with respect to the instant member, the Defendant Corporation requested the Minister of Health and Welfare (hereinafter “Defendant Minister”) to conduct on-site investigations with respect to the instant member on June 3, 2014.

C. From October 19, 2015 to December 21, 2015, Defendant Minister conducted an on-site investigation (the period subject to investigation: the period from July 19, 2013 to June 2, 2015 to June 8, 2015; hereinafter “instant on-site investigation”) on the instant member, and determined that the Plaintiff was unfairly claimed and paid medical care benefit costs as follows.

2. Details of unfair amount calculation;

(a) Unfair amount: 42,460,590 won;

B. After examining and treating the details of calculation of the unfair amount, the claim for medical care benefit costs: 42,460,590 won - The difference between the total unfair amount and the unfair amount by detailed details of the medical care benefit cost, according to Article 9(1) [Attachment 2] of the former Regulations on the Standards for Medical Care Benefits in National Health Insurance (amended by Ordinance of the Ministry of Health and Welfare No. 431, Aug. 4, 2016; hereinafter “former Regulations on Medical Care Benefits”).

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