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(영문) 서울행정법원 2019.01.24 2017구합86118
요양기관업무정지처분취소청구
Text

1. The Plaintiff is the 20th day (from March 26, 2018 to April 14, 2018) of September 5, 2017 by the Minister of Health and Welfare.

Reasons

1. Details of each disposition;

A. From June 30, 2010, the Plaintiff, as a doctor, established and operated a “Cansan Hospital” (hereinafter “instant hospital”) which is a health care institution under the National Health Insurance Act on the third and third floor of Ulsan-gu, Ulsan-gu.

B. On April 25, 2013, the Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) received information on civil petitions, and conducted on-site verifications with respect to the instant hospital (hereinafter “on-site verification”). As a result, on August 19, 2013, Defendant Minister of Health and Welfare (hereinafter “Defendant Minister”) requested the instant hospital to conduct on-site verifications with respect to the instant hospital.

C. The Defendant Minister conducted a field investigation on the instant hospital from May 19, 2014 to the 27th day of the same month (the period subject to investigation: January 2012 to March 201, August 8-10, and January through March 3, 2014; hereinafter “instant field investigation”) and thereafter, conducted a field investigation on the instant hospital (the period subject to investigation was extended to April 201 to March 201, and March 2014; hereinafter “instant field investigation”). As a result, the Plaintiff was unjustly claiming for medical care benefit costs as follows.

2. Details of unfair amount calculation;

(a) Unfair amount: 46,856,950 won;

B. A double claim for medical care benefit costs and unfair claims: 29,182,261 won - 29,182,261 won - A medical care benefit claim for medical care benefit costs, examination fees, etc. (hereinafter “reason 1 for Disposition”) - Medical care benefit cost claim for medical care benefit costs by issuing medical care benefit costs and claiming pharmacy medication costs (hereinafter “reason 2 for Disposition 2”), even if the surgery was performed in installments on a day, and collected the costs from the winners as non-benefit, and even if the costs were collected as non-benefit to the winners, it was recorded as a medical care benefit claim on a different day and recorded as a medical care benefit claim.

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