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(영문) 서울행정법원 2019.04.18 2018구합76453
업무정지처분취소
Text

1. All of the plaintiff's claims are dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is a person who established and operated a C convalescent Hospital (hereinafter “instant hospital”) in the Busan Ho-gu building B.

B. The Defendant conducted an on-site investigation of the instant hospital’s medical benefits and medical benefits by setting the investigation period from January 2014 to September 2015 and from July 2016 to September 2016.

C. On May 31, 2018, the Defendant issued a disposition to suspend the business of an institution providing medical care for 91 days, based on Article 28(1)1 of the National Health Insurance Act, on the ground that the Plaintiff violated the standards for calculating hospitalization fees in a convalescent hospital in accordance with the foregoing on the ground that the Plaintiff was unfairly paid the medical care benefit costs of KRW 87,684,070 in total from the National Health Insurance Corporation (hereinafter “Corporation”) in violation of the standards for calculating hospitalization fees in a convalescent hospital by the following methods, and on June 1, 2018, the Defendant issued a disposition to suspend the business of an institution providing medical care for 89 days, based on Article 98(1)1 of the National Health Insurance Act.

(hereinafter the above medical care institution’s business suspension disposition and the above medical care institution’s business suspension disposition (hereinafter “each of the instant dispositions”). Health insurance act’s list of benefits and non-benefits, and the relative value point of benefits in Part III of the relative value point of benefits in convalescent care institutions [calculated Guidelines]

4. D.

According to the differential rate system of hospitalization fees based on the level of human resources for doctors, the grade of hospitalization fees shall be calculated based on the number of full-time doctors (the number of medical doctors) in the relevant medical care institution compared to the average number of patients for the immediately preceding quarter. In accordance with the criteria for differential application of hospitalization fees in a long-term care hospital according to the level of securing human resources for doctors under Article 2009-214 of the Ministry of Health and Welfare’s notification, a part-time or day-day doctor is 0.5 if he/she is at least 3 days per week and at least 20 hours per week. However, in the case of doctor D, he/she has worked only one day from September 15, 2014 to October 5, 2014.

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