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(영문) 서울행정법원 2016.01.28 2015구합68086
장기요양급여비용환수처분취소
Text

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

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

Reasons

The plaintiff of each of the dispositions of this case is a person operating the "B medical care center" (hereinafter "the medical care center of this case") and the "B Elderly Welfare Center" (hereinafter "the Welfare Center of this case") providing facilities benefits, etc. under the Long-Term Care Insurance for the Aged.

The Defendant and the head of Gyeyang-gu Incheon Metropolitan City jointly conducted an on-site investigation (from May 16, 2013 to October 31, 2014) on the instant medical care center and the elderly welfare center from December 16, 2014 to December 19, 2014.

(hereinafter “instant on-site investigation.” Based on the result of the instant on-site investigation, the Defendant rendered a disposition to recover expenses for long-term care benefits of KRW 10,597,520 to the Plaintiff on March 13, 2015, pursuant to Article 43(1)3 of the Act on Long-Term Care Insurance for the Aged (hereinafter “instant Disposition 1”); 【Grounds for Disposition】

1. 1-(1) 'The reason for the disposition' is 'the reason for the violation of the criteria for manpower placement; and

Until May 7, 2013, to August 4, 2014, a caregiver C makes an unfair claim for expenses for long-term care benefits as long as he/she performs a caregiver's duties for at least 160 hours a month, even though he/she actually takes exclusive charge of the kitchen's duties.

2. On the same day as a daily claim for the number of expenses for long-term care benefits of KRW 5,564,560 in accordance with the Act and subordinate statutes for the following grounds in relation to the welfare center for older persons of this case during the period of stay:

(hereinafter “instant Disposition 2”). 【Grounds for Disposition】

1. 2-(1)(a) is the reason for disposition by a caregiver who is a family member, while serving in the occupation and making a request after the provision of the service;

If a caregiver, who is a family member, provides a beneficiary with benefits while engaging in another occupation, he/she shall not calculate the relevant expenses for benefits; but ① A caregiver D is a beneficiary and his/her family member while working for at least 160 hours a month at the Welfare Center for the Aged in this case as a caregiver and serving for at least 160 hours a month as a caregiver.

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