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1. The Plaintiff and the National Health Insurance Corporation shall recover expenses for long-term care benefits from KRW 26,197,040, May 27, 2016.
Reasons
1. Details of the disposition;
A. From September 3, 2008, the Plaintiff operated the “B Center” (hereinafter “instant medical care institution”) which is a long-term care institution for long-term care from around September 3, 2008, pursuant to Article 32(1) of the Act on Long-Term Care Insurance for the Aged (hereinafter “the instant medical care institution”), provided for visiting medical care and bathing for home care under Article 23(1)1(a) and
B. Meanwhile, the Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) takes charge of the imposition and collection of long-term care insurance premiums, the management and evaluation of long-term care benefits, and the verification of details of the provision of long-term care benefits (Article 48(2) of the Long-Term Care Insurance Act). Around February 2016, Defendant Corporation confirmed the suspected charge of an unfair claim for expenses for long-term care benefits while checking the details of the provision of long
C. Around February 2016, the Defendant Kimhae-si was requested by the Defendant Corporation to conduct an on-site investigation with respect to the instant medical care institution. From March 7, 2016 to March 10, 2016, it conducted an on-site investigation with respect to the instant medical care institution pursuant to Article 61(2) of the Long-Term Care Insurance Act, along with the Defendant Corporation.
As a result of the above on-site investigation, the defendant Kimhae-si may claim medical care benefit costs by gathering the number of days for which visit medical care benefits are provided, such as claiming medical care benefits costs for the period during which the medical care benefits are not provided due to departure or hospitalization of the caregiver, and ② the visit bathing benefits are provided, despite the fact that the beneficiary’s bathing assistance and the body cleaning process (hereinafter “the body cleaning process”) must be provided by more than two caregivers (the notice of the criteria for the provision of long-term care benefits and the calculation method of expenses for long-term care benefits (the notice of the Ministry of Health and Welfare No. 2018-130, hereinafter “the notice of this case”).
Article 24(2) of the Act, only one caregiver shall participate in the body process, and the following medical care benefit costs.