2015Du356 Revocation of Disposition of Imposition of Penalty Surcharges

1. A;

2. B

The Minister of Health and Welfare

Seoul High Court Decision 2014Nu6502 Decided December 24, 2014

June 15, 2017

The judgment below is reversed, and the case is remanded to Seoul High Court.

The grounds of appeal are examined.

1. The burden of proof in an administrative litigation to which the provisions of the Civil Procedure Act apply mutatis mutandis is, in principle, allocated among the parties in accordance with the general principles of civil procedure. In the case of an appeal litigation, the Defendant bears the burden of proving the lawfulness of the disposition based on its nature. In a case where the Defendant proves a reasonable and acceptable reply with respect to the grounds for disposition that support the legality of the disposition, the assertion and proof of exceptional circumstances must return to the Plaintiff, the other party, as the other party (see Supreme Court en banc Decision 2010Du27639, Jun. 18, 2012; Supreme Court Decision 20

10. According to the reasoning of the lower judgment and the evidence duly admitted by the lower court, etc., the following facts are revealed.

① According to the “Detailed Rules on the Standards and Methods of Medical Care Benefits” (amended by Presidential Decree No. 2007-3 of Jan. 23, 2007, which was amended by Ministry of Health and Welfare No. 2011-144 of Nov. 25, 201) concerning the criteria for recognition of the operation of gold cells using artificial tapes (hereinafter “instant standard for recognition of benefits”) in order to apply the National Health Insurance for the number of gold required for the purpose of applying the National Health Insurance for the alcohol in accordance with the “Standard for Recognition of Benefit” (hereinafter “instant standard for recognition of benefit”).

(2) The epidemology test is a test that identifies physiological and scopic functions for breathic and scopic functions, and is usually conducted by checking whether urines have leaked in various circumstances, such as artificially injecting physiological infected trees in the light of a patient, and allowing the patient to scopher, or to force times to do so. considering the characteristics of the test’s progress, it is common that the ex-scopic type and the number of tests expressed in the results of the test are different for each test even if the same patient is the same.

③ A Co., Ltd. is a company that sells imported from abroad epidemology test machinery and/or gold cell surgery materials to local workers and council members. D, as an employee of the above company, performed the business of installing machinery and explaining the method of using the machinery to industrial workers and council members who purchased the epidemiologic test machinery from the above company. He explained the method of using the machinery in an opportunity to explain the method of using the machinery.

④ If the result of the epidemology examination conducted on a patient subject to the epidemian surgery does not meet the instant wage recognition standard, but if the use of the inspection machines is found to have been carried out, it was requested D to operate the results of the examination.

⑤ There were three methods to manipulate D’s results of inspection. The first method is to change the patient’s existing inspection and/or the date of inspection, and to cover the patient’s name and/or date of inspection, or to copy the existing inspection and/or inspection and/or to copy the existing inspection and/or inspection and/or to use the rupture function to arbitrarily manipulate the rupture of the rupture, and the third method is to continuously divide the rupture and pressure of the rupture in the event that the rupture and pressure of the rupture are measured by negative pressure, and the third method is to adjust the rupture so that the rupture can be corrected by ( zero).D used first method in the event that the rupture itself of the patient subject to an operation is inferior, but the rupture itself was partially modified by means of measuring the 120cupture of the rupture.

6) As the result of the examination of a patient who operated by the first method is accompanied by a copy of the existing test result of another patient, the malpology and test result are the same, and if the first method is mixed with the second method, some differences can occur in the malpology and test result. In order to operate the test result by using the first method, the previous test result of another patient meeting the benefit standard of this case must be carried out (the "salpology"). D used the test result to explain the methods of inspection to medical doctors and nurses, and the test result provided by the manufacturer of inspection machinery, which is based on the basis of the manufacturer of inspection machinery.

7) In a case where a crypology test is conducted by each mountain father and a National Assembly member, the test results are automatically stored on the relevant inspection machine, but when D operates the test results, they are stored by cover only the operational test results, and the previous test results were automatically deleted. D even until the beginning of 2008, each mountain father and a National Assembly member stored the previous test results in the inspection machine purchased by each mountain father and National Assembly member so that they can be used for the operation of the test results. At the request of each mountain father and National Assembly member, the test results that were carried out by storing and using the normal US USB camera in the course of manipulating the test results, and other test results stored in the inspection machine with the relevant mountain father and National Assembly member were used for those.

③ From January 1, 2009 to August 31, 2009, the Plaintiffs’ operation from “E Council members” to “E Council members,” and the Plaintiffs’ operation from January 1, 200 to October 201.

1. From December 31, 2010 to December 31, 2010, the result of the epidemology test on a total of 18 cases of the 11-month surgery is identical or equivalent to the result of another patient’s test and the result of the epidemology test on a total of 18 cases.

On January 10, 2012, the Defendant issued a disposition of imposition of a penalty surcharge of KRW 67,502,150 in lieu of business suspension against the Plaintiffs on the ground that: (a) based on the result of the investigation that the Plaintiffs conspired as if they were eligible for national health insurance benefits; (b) performed the required amount operation on the basis of the results of the investigation conducted as if they were eligible for national health insurance benefits; and (c) received the total amount of KRW 13,50,430 in lieu of the costs of health care benefits.

B. Examining these facts in light of the legal principles as seen earlier, it is reasonable to view that the Defendant’s grounds for disposition related to the claim for expenses incurred in performing the surgery are reasonably acceptable in the following respect, and it is reasonable to view that the allegations and proof contrary to the above are returned to the Plaintiff, the other party, as the Plaintiff.

(1) Where, among the results of the epidemology test, the numerical value of which is identical or substantial, the date of the test is the original which is not fabricated, and the date of the test is at the latest likely to be fabricated using the original data, it shall be guaranteed that the third original (existing sampling) of this test has little probability of being used for the operation of these results.

② However, D, at the request of each mountain father and a National Assembly member, stored and used the results of the inspection that was carried out by storing them in Pyeongtaek U.S. dollars. By the beginning of 2008, D stored basic sampling in inspection machinery with each mountain father and a National Assembly member.

③ Four cases where the lower court determined that it was probable to be the result of a true inspection are the same as the number of winners who have undergone an examination or operation at another hospital, and the dysp type and the numerical value of the examination.

④ Therefore, in a case where the numerical value of a ethmpology and the result of the ethrology test coincides with the same or considerable parts, the result of the test is much more likely to be distorted by the use of the original (existing sampling) of the third original, rather than the likelihood that the date of the test would be the true original.

⑤ While recognizing the fact that there was an unfair claim by manipulating the outcome of the examination at any time, the genuine result of the examination did not be deleted or discarded at the same time as the operation, and there is no specific knowledge about what kind of epidemiologic results were fabricated as at the time of the disposition in this case. On the other hand, although there was a possibility of manipulating the result of the examination by other methods than the aforementioned first method, the Defendant merely considered only the case where, among the result of the epidemiologic examination, the number of the epidemiology and the test was identical or corresponding to the same part as the result of the epidemiologic examination in this

C. Nevertheless, the lower court determined otherwise, on the ground that, in a case where the ex-postp and examination result coincides with the same or considerable part of the results of the ex-postponology examination, the pre-inspection date is probable to be an original copy that was not fabricated as a result of the examination, the part concerning such four of the instant disposition is unlawful. In so determining, the lower court erred by misapprehending the legal doctrine on the burden of proof of the grounds for disposition, thereby adversely affecting the conclusion of the judgment by exceeding the bounds of

3. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Jo Hee-de

Justices Kim Chang-suk

Justices Park Sang-ok