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(영문) 수원지방법원 2020.01.08 2018가합27778
손해배상(기)
Text

1. The Defendants jointly share KRW 3,492,129,330 with respect to the Plaintiff and the period from August 6, 2016 to February 21, 2019.

Reasons

1. Basic facts (applicable for recognition: Fact that there is no dispute, entries in Gap evidence 1, 2, 3, and 4 (including each number), the purport of the whole pleadings);

A. On December 16, 2014, the Defendants established and operated a medical institution under the name of “G convalescent Hospital” in the name of “G convalescent Hospital,” even though they are not medical personnel.

B. The Plaintiff paid the sum of KRW 3,492,129,330 as the medical care benefit cost upon the request of the pertinent hospital from around December 16, 2014 to August 5, 2016.

2. Articles 33(2), 66(1)2, and 87(1)2 of the Medical Service Act limit the qualifications of a person who established a medical institution to intent, etc., and, on the other hand, a medical person employed by a person who is unable to establish a medical institution to provide medical services, prohibits a person who is not qualified to establish a medical institution from strictly establishing a medical institution, such as setting the grounds for suspending his/her qualification, and imposes criminal punishment on such person to contribute to protecting and promoting national health by ensuring the appropriateness of medical treatment.

In addition, Article 42 (1) of the National Health Insurance Act provides that health care benefit shall be provided by the "medical institution established under the Medical Service Act".

Therefore, if medical care benefits were paid at a medical institution that was not lawfully established in violation of Article 33(2) of the Medical Service Act, the pertinent medical institution does not constitute a medical care institution that can claim medical care benefits under the National Health Insurance Act, and thus, the above medical care benefits cannot be included in the medical care

As above, if a person who is not eligible to establish a medical institution employs a doctor, establishes a medical institution, and let the employed doctor conduct medical treatment, and then claims and pays medical care benefit costs not included in the medical care benefits to the National Health Insurance Corporation, which is the insurer, it shall not be subject to medical care benefits.

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