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(영문) 대법원 2015.10.29 2015두45069
의료급여비환수처분 취소
Text

The judgment of the court below is reversed, and the case is remanded to Daejeon High Court.

Reasons

The grounds of appeal are examined.

1. Article 23 (1) of the Medical Care Assistance Act provides that the head of a Si/Gun/Gu shall collect all or part of an amount equivalent to the relevant benefits or expenses for medical benefits from a person who received medical benefits or a medical care institution who received expenses for benefits by deceit or other unjust means

In addition, Article 7(2) of the former Medical Care Assistance Act (amended by Act No. 11878, Jun. 12, 2013) provides that the standards for medical care, such as the method, procedure, scope, and method of medical care, shall be prescribed by Ordinance of the Ministry of Health and Welfare concerning the standards for medical care, and the method of calculating the number of medical care fees. Under Articles 6 and 8 of the Enforcement Rule of the Medical Care Assistance Act, and Articles 5(2) and 8(2) of the Regulations on the Standards for Medical Care Benefits in National Health Insurance, detailed matters concerning the standards for and methods of applying medical care benefits shall be prescribed by the Minister of Health and Welfare. Accordingly, the list of expenses for health insurance action and the calculation of the number of health care allowances, which are determined and publicly notified by the Minister of Health and Welfare, shall be divided into classes 1 through 8, and accordingly, the criteria for and method of applying medical care benefits (hereinafter “instant standards”) shall be determined to include the average number of nursing personnel in the immediately preceding quarter as the average number of nursing (1 month).

Meanwhile, Article 55 of the former Labor Standards Act (amended by Act No. 12325, Jan. 21, 2014; hereinafter “Labor Standards Act”) is an employer.

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