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(영문) 대전지방법원 2018.07.19 2017구합106007
업무정지처분취소
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. From April 21, 1998, the Plaintiff is operating the Ulsan-gu Branch of C (hereinafter “instant hospital”).

B. From October 19, 2015 to October 21, 2015, the Defendant conducted an on-site investigation into the insurance medical and pharmaceutical expenses before and after vision correction, setting the investigation period from August 19, 2012 to January 2014, and from May 2015 to July 2015, the Defendant conducted an on-site investigation into the insurance and pharmaceutical expenses before and after vision correction.

(hereinafter “instant on-site investigation”). C.

On December 6, 2016, the Defendant issued a prior notice on the disposition to the Plaintiff. On August 2, 2017, “The Plaintiff, between August 2, 2012 and January 2, 2014, performed vision correction, etc. to substitute for non-benefits, contact lensess, etc. pursuant to attached Table 2, pursuant to Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance, and claimed medical care benefit costs, etc. (the claimed amount KRW 25,974,130), and claimed medical care benefit costs, etc. (the claimed amount KRW 25,974,130), issued nuclear prescription as the subject of medical care benefits, and demanded the Plaintiff to pay pharmacy medication expenses (the claimed amount KRW 89,082,324)” on the ground that “The Plaintiff’s business suspension of health care institutions [Attachment Table 5] pursuant to Article 9(1)1 of the National Health Insurance Act and Article 70(1) [Attachment 5]

(hereinafter “instant disposition”) D.

The details of the instant disposition period are as follows.

The total amount of costs of health care benefit for the investigation period (from August 2012 to January 2014; from May 2015 to July 2015; and from July 2015; and from February 21, 2015 to February 4,373; 149; 115,050; 270; 5, 478, 5842.630 (unit: KRW 1,50; KRW 15,050; %) [the fact that there is no dispute over the grounds for recognition; Party A’s evidence 1, 2; and Party B’s evidence 1]

2. Summary of the plaintiff's assertion

A. (1) The instant act and prescription are subject to medical care benefits, and the Defendant is within 30 days prior to the surgery.

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