The defendant shall pay 129,401,506 won to the plaintiff and 20% per annum from December 2, 2014 to the day of complete payment.

Basic Facts

The plaintiff is a medical corporation that operates a medical care institution's main hospital under Article 42 (1) 1 of the National Health Insurance Act (hereinafter referred to as the "Act") in Busan Jung-gu. The defendant is the health insurance insurer established pursuant to the provisions of Chapter 3 of the Act, and the Health Insurance Review and Assessment Service (hereinafter referred to as the "Review and Assessment Service") is a corporation established pursuant to Article 62 of the Act to examine medical care benefit costs

Under the Health Insurance Act, the subject of the health insurance program consists of three types of relationship between the Defendant, a medical supplier, and a subscriber. The process of paying the health care benefit is the process of medical care benefit payment, upon receiving a policyholder’s visit from a health care institution, a health care institution requests the Review and Assessment Service for review of the health care benefit. The Review and Assessment Service, upon delegation from Article 41(2) and (3) of the Act, examines whether the claimed details meet the criteria such as “Rules on the Standards and Methods for Medical Care Benefits under National Health Insurance” established under the delegation from Article 41(2) and “Detailed Rules on the Standards and Methods for Medical Care Benefits” publicly notified by the Minister of Health and Welfare, and then notifies the medical care institution and the Defendant of the outcome

Before a medical institution enters into force of the past medicine business, medical institution claimed medical care benefit costs for medicine costs and received them to the defendant. If the defendant considers that the claim for medicine costs violate the standards of law, it is reasonable to charge medicine costs based on Article 45(1) of the former Medical Insurance Act (amended by Act No. 5854 of Feb. 8, 1999) and Article 44(1) of the former National Medical Insurance Act (amended by Act No. 5854 of Feb. 8, 199).