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(영문) 서울행정법원 2017.09.28 2017구합1223
장기요양급여비용 환수결정처분 취소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

The details and details of the disposition are as follows: (a) in Chuncheon City B, the Plaintiff is establishing and operating the Cmedical Care Center, a long-term care institution (hereinafter “instant medical care center”).

As a result of the instant on-site investigation of the medical care center (hereinafter “instant on-site investigation”) conducted from January 1, 2015 to April 17, 2016 during the period of investigation from June 13, 2016 to June 17, 2016, the Defendant determined that the Plaintiff claimed and received KRW 127,97,980 for expenses for long-term care benefits by fraud or other improper means as follows:

(1) A long-term care institution shall comply with relevant statutes, place and operate human resources in compliance with the standards for admission facilities, and claim expenses for long-term care benefits in accordance with the standards for public announcement of expenses for long-term care benefits in accordance with the fact that expenses for long-term care benefits are provided at the time of claiming expenses for long-term care benefits.

D, registered as a physical clinic from March 2015 to February 2016, failed to meet the monthly standard working hours due to an individual’s failure to attend a university, graduate school part-time lecturer, or to meet the monthly standard working hours due to his/her departure from Korea, preparation for retirement, etc., but the Plaintiff was registered differently from the fact, and was paid for expenses incurred in providing benefits, instead of applying reduction calculation due to a violation of the standards for placement of physical clinic personnel on March 4, 2015, 6.7., 11., 12., 12., 2016.

(2) Pursuant to Article 67 (2) 2 of the "Public Notice on Standards for Providing long-term care benefits, methods for calculating expenses for long-term care benefits, etc.", reduction calculation shall not be applied to working hours for at least the standard working hours for the immediately preceding six months on the basis

In March 2016, 2016, the physical clinic D claimed the expenses for benefits to the defendant without applying reduction calculation, even though it failed to meet the standard monthly working hours for the six immediately preceding months on the basis of the month in which the date of retirement falls.

2. Violation of criteria for additional placement of human resources;

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