Where an institution recognized as a rehabilitation and physical therapy institution conceals the fact that it falls short of the human resources standards set forth in the public notice of physical care and treats physical care, whether the physical care expenses cannot be calculated as medical care benefit costs, even if there was no disposition for recognition or termination of the institution for physical care.

Article 35(1) of the Medical Insurance Act and Article 89-72 of the Public Notice of the Ministry of Health and Welfare [Calculation Guidelines] Article 7(1) and (3) of the Medical Fees Standards (No. 89-72) of the Medical Fees Standards (No. 89-72 of the Public Notice of the Ministry of Health and Welfare) impose an obligation to apply without delay to an institution recognized as an institution responsible for rehabilitation and water treatment to change its human resources, facilities, and equipment, and to obtain the recognition of the institution. In addition, if the medical institution discovers such fact, it shall without delay terminate its recognition. In light of the purport of Article 35(1) of the Medical Insurance Act and Article 35(1) of the Medical Fees Standards (No. 89-72 of the Medical Fees Standards) and Article 89-72 of the Public Notice of the Ministry of Health and Welfare, however, if the institution recognized as the institution has concealed its failure to meet the human resources standards and continued physical treatment, it shall not be interpreted as a cost for physical treatment.

Articles 29(2), 32(1), 33(2), and 35(1) of the Medical Insurance Act

[Judgment of the court below]

Medical Insurance Federation Law Firm 000,000,000

Seoul High Court Decision 93Gu9141 delivered on April 21, 1994

The part of the lower judgment against the Defendant’s failure is reversed, and that part of the case is remanded to the Seoul High Court.

We examine the grounds of appeal.

1. The court below held that the plaintiff's non-party 2 obtained a license for physical therapy on July 30, 1990 under Appendix 89-72 of the Public Notice of the Ministry of Health and Social Welfare, which had established and operated a medical clinic and provided physical therapy treatment from the defendant on July 30, 190, and the non-party 1, a physical therapy hospital, retired from the plaintiff's clinic on November 15, 1990, the period from November 16, 1990 to March 31, 191 without employing a physical therapy hospital, and the non-party 2 could not, as a matter of course, obtain a license for physical therapy treatment for the above period from April 1, 199 to April 27, 199. The court below held that the non-party 1 could not, as a matter of course, obtain a license for physical therapy treatment for the above period from the plaintiff's medical institution for physical therapy, and that the non-party 1 could not, as a matter of course, delay in the plaintiff's license for physical therapy.

2. Article 35(1) of the Medical Insurance Act provides that expenses for medical care benefits or delivery benefits shall be calculated by the Minister of Health and Welfare in accordance with the standards determined by the Review Committee after deliberation. Chapter 7 of the Medical Fees Standard established under Article 35(1) of the Medical Care Act [Calculation Guidelines] of the Medical Fees Standard established under Article 89-72 of the Ministry of Health and Welfare [3] of the Medical Care Act provides that "only when the medical institution provides for rehabilitation and physical treatment purposes among the classification categories of this Chapter, it may be calculated only when the medical institution approved by the Review Committee in accordance with the standards for recognition of the institutions providing rehabilitation and physical treatment." The above provision provides that "the standards for recognition of the medical fees" (Article 89-72 of the Ministry of Health and Welfare) of the Medical Care Act provides that "the institution providing rehabilitation and physical treatment for the recognition of the institutions providing rehabilitation and physical treatment shall be recognized as the institution providing for the calculation of medical fees without delay."

When the above provisions do not meet the above human resources standards, facilities, and equipment standards for rehabilitation and water treatment institutions, the medical expenses examination institution shall apply for the change of the medical expenses examination institution without delay to obtain the recognition of the institution. In addition, the medical expenses examination institution shall terminate the recognition without delay, and in light of the purport that the medical expenses examination institution shall calculate the medical fees in compliance with each classification item's medical expenses and the medical expenses examination institution's facilities, equipment, and human resources standards, although the above examination institution does not explicitly provide for the public notice, if the medical expenses are concealed that the institution recognized as the institution did not meet the human resources standards and continued to provide physical treatment, it shall be interpreted that the expenses for physical treatment shall not be calculated as the expenses for medical benefits even if there was no disposition for the recognition of the institution for physical treatment.

Therefore, the judgment of the court below that even if physical therapy does not meet the requirements prescribed in the above recognition criteria because there is no physical therapy doctor, if a doctor in the general surgery directly treats physical therapy, he may claim expenses for the medical care benefits. The judgment below erred by misapprehending the legal principles as to the Medical Insurance Act and the above public notice of the health society, and such illegality affected the judgment. Therefore, there is a reason to point this out.

3. Therefore, the part of the judgment of the court below against the defendant's failure shall be reversed, and this part of the case shall be remanded to the court below. It is decided as per Disposition by the assent

Justices Jeong Jong-ho (Presiding Justice)