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(영문) 서울행정법원 2015.11.26 2015구합62019
업무정지처분 및 부당금액확정통보처분 취소 청구의 소
Text

1. All part of the instant lawsuit seeking revocation of the determination of unfair amount and notification disposition shall be dismissed.

2. The plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is an oriental medical doctor operating the Chanwon (hereinafter “instant Institute”) in the 2nd floor of the Seoul Southern-gu Seoul Metropolitan Government building (hereinafter “instant building”).

B. From May 13, 2013 to May 15, 2015 of the same month, the Defendant conducted an on-site investigation (from April 2010 to December 2010, and from January 2013 to March 2013, 2013) with respect to the instant member.

(hereinafter “instant on-site investigation”) C.

On March 23, 2015, the Defendant issued a disposition of business suspension on 63 days (from May 25, 2015 to July 26, 2015) pursuant to Article 98(1)1 of the National Health Insurance Act (hereinafter “instant disposition”), and notified the Plaintiff of the unfair amount of medical care benefit costs on the same day as 22,986,310 won.

(hereinafter “instant No. 1 Notice”). 1. Calculation details of unfair amount

(a) Unfair amount: 22,986,310 won;

B. False statement of calculation of the unfair amount: 22,986,310 won - In the case of some wounded persons, the medical records were recorded in the medical records and the medical records and the claim for medical examination fees and oriental medical treatment fees, etc. (hereinafter “reasons for Disposition 1”) - The medical records and the claim for medical treatment fees and oriental medical treatment fees, etc. (hereinafter “reasons for Disposition 1”) pursuant to attached Table 2 of the Regulations on the Standards for Medical Care Benefits in National Health Insurance - The medical records were provided with medical treatment for the injury or disease, such as “comfort or oriental medical treatment” after collecting the relevant expenses from the person who received the medical records as non-payment, and recorded them in the medical records and claimed medical examination fees and oriental medical treatment fees, etc. (hereinafter “reasons for Disposition 2”).

2. Grounds related to the calculation details of administrative disposition: The total amount of health care benefit costs (from April 2010 to October 201, 201; from January 201 to March 3, 2013; 22 months) subject to the investigation of the standard calculation details of business suspension and imposition of penalty surcharges under Article 70(1) [Attached Table 5] of the Enforcement Decree of the National Health Insurance Act is the monthly average unjust amount.

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