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(영문) 서울행정법원 2019.05.23 2018구합61383
업무정지처분취소
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 the disposition;

A. The Plaintiff, as an oriental medical doctor, has established and operated a “A” medical care institution under the National Health Insurance Act (hereinafter “A”), which is a medical care institution under the Daegu Seo-gu.

2. Details of unfair amount calculation;

(a) Unfair amount: 69,063,260 won;

B. In the case of a certain number of days of calculation of the unfair amount - KRW 51,308,570 of the false statement of calculation - In the case of a false statement of diagnosis fees, etc., the medical records are recorded in the medical records and false statement of diagnosis fees, etc. as medical care benefit cost claim (hereinafter “instant ground for disposition 1”) - In the case of a certain number of persons, the medicine expenses, etc. were invested in the medical records even though they did not contain the actual Han-gu Han-gu galivium, etc., and the difference between the total unfair amount of the unfair statement and the unfair amount of each detailed statement with the ground for disposition 1 of this case is the amount accrued in the course of a single statement of national funds (hereinafter “instant ground for disposition 2 of this case”).

B. Around May 2017, the Defendant Minister of Health and Welfare (hereinafter “Defendant Minister”) conducted an on-site investigation (the period subject to the investigation: from April 2014 to March 2017; hereinafter “instant on-site investigation”) with respect to a Council member, and determined that the Plaintiff filed a false claim for medical examination fees, medicine expenses, etc. as follows:

C. On January 17, 2018, based on the results of the instant on the ground of the results of the instant on-site investigation, Defendant Minister issued a disposition of business suspension to the Plaintiff on 96 days (from July 27, 2018 to October 30, 2018) pursuant to Article 98(1)1 of the National Health Insurance Act and Article 70(1) [Attachment Table 5] of the former Enforcement Decree of the National Health Insurance Act (amended by Presidential Decree No. 29002, Jun. 26, 2018; hereinafter the same shall apply) (hereinafter referred to as “instant disposition of business suspension”), and the detailed calculation details thereof are as follows.

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