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(영문) 서울행정법원 2018.04.05 2017구합70274
영업정지처분취소
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. The Plaintiff, as a doctor, has opened and operated the building B in Ulsan-gu and C Council members on the third floor (hereinafter “instant Council members”).

B. On April 19, 2013, the Defendant conducted an on-site investigation (the period subject to the investigation: from March 2010 to May 2011; from December 2012 to February 2013; hereinafter “instant on-site investigation”) on the instant member; and as a result, determined that the Plaintiff received the payment of the costs of health care benefit by unfairly claiming for the payment of the total amount of 785 progresss as follows.

A double claim for medical care benefit costs after non-benefit medical treatment: 12,236,830 won - Pursuant to Article 9(1) [Attachment 2] of the former Rules 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 Rules on Standards for Medical Care Benefits”), a person who conducted removal, etc. subject to non-benefit medical care benefits and collected the expenses from a person who received an injury to a disease, such as “non-benefit” and claims for medical care benefit costs after recording the examination fees, etc. (hereinafter “instant grounds for disposition”).

C. On May 24, 2016, the Defendant issued a disposition to suspend the business of a medical care institution for 20 days as follows, based on Article 98(1)1 of the former National Health Insurance Act (amended by Act No. 13985, Feb. 3, 2016; hereinafter the same) on the basis of the result of the instant on-site investigation, following the Plaintiff’s submission of opinions.

(hereinafter referred to as “instant disposition”). 3. Grounds related to the calculation details of administrative disposition: Attached Table 5 of Article 70(1) [Attachment 5] of the former Enforcement Decree of the National Health Insurance Act (amended by Presidential Decree No. 27433, Aug. 2, 2016; hereinafter the same shall apply), the total amount of medical care benefit costs subject to investigation (from March 2, 2011 to May 2, 2011; from December 2, 2012 to February 18, 2013; 642,416, 290 won 12,236,830 won 679,8230 won ; 1.90% of the total amount of medical care benefit costs subject to investigation (from December 2, 2012 to February 18, 2013) shall be as of April

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