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(영문) 서울행정법원 2019.06.27 2018구합82472
장기요양급여비용 환수처분 취소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Circumstances and details of the disposition;

A. The Plaintiff is a person who establishes and operates a “C Elderly Welfare Center” (hereinafter “instant long-term care institution”), a long-term care institution for long-term care in Article 32 of the Act on Long-Term Care Insurance for the Aged in South-si.

B. On June 4, 2018, the Mayor of Namyang-ju and the Defendant conducted an on-site investigation as to whether the instant long-term care institution’s claim for long-term care benefit costs is appropriate.

(Period of Investigation: from April 2017 to April 2018; hereinafter referred to as “instant on-site investigation”). (C)

On August 20, 2018, the Defendant issued a disposition to recover expenses for long-term care benefits of KRW 42,470,220 on the basis of “Article 43(1)3 of the Long-Term Care Insurance Act for the Aged” to the Plaintiff.

(hereinafter “instant disposition”). The grounds for restitution stated in the instant disposition are as follows.

Redemption Grounds: H02 (Claims by increasing the number of days and frequency of services), H04 (Claims by increasing service hours), H13 (Violation of Standards for Placement of Human Resources), and 501 (Entry in Other Reasons)

D. On January 9, 2019, the Defendant reduced and refunded KRW 3,407,010 (the part on violation of the criteria for placement of human resources as of March 2018 and April 2018) out of the amount of the instant disposition as follows.

As a result, the amount of the instant disposition was reduced to KRW 39,063,210 (=42,470,220 - 3,407,010).

[Ground of recognition] Unsatisfy, Gap evidence Nos. 1, 2, and 5, the purport of the whole pleadings

2. Whether the instant disposition is lawful

(a) Recognition (the instant long-term care institution / Daytime protection)

1. An institution that has filed an application for the criteria for placement of human resources shall have facilities and human resources pursuant to Article 23 of the Enforcement Rule of the Long-Term Care Insurance Act, and an institution that has filed an application for the calculation of expenses incurred in providing long-term care benefits and methods of calculating expenses incurred in providing long-term care benefits (Notice of the Ministry of Health and Welfare No. 2016-242, Dec. 22, 2016), among human resources reported to the head of the competent Special Self-Governing City Mayor/Do Governor, shall record

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