Plaintiff (Attorney Yoon Young-young, Counsel for the plaintiff-appellant)

Health Insurance Review and Assessment Service (Attorney Park Jong-chul, Counsel for defendant-appellant)

March 19, 2015

1. The plaintiff's claim is dismissed.

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

The part of KRW 9,200,000 pertaining to constant cancer treatment shall be revoked among the disposition of confirmation and notification of excessive personal charges against the Plaintiff on March 14, 2014 by the Defendant to Nonparty 1.

1. Details of the disposition;

A. Status of the parties

The Plaintiff established and operated ○○○○ Hospital (hereinafter referred to as the “instant hospital”) located in Busan-gun ( Address omitted). The Defendant is a corporation established under Article 55 of the National Health Insurance Act on June 29, 2000 in order to examine medical care benefit costs and assess the appropriateness of medical care benefits.

(b) Determination on whether to apply for medical care benefits;

1) From July 5, 2012 to December 3, 2012, Nonparty 1: (a) hospitalized at the instant hospital due to the disease of “the organ where it is missing or of the abandoned malicious life”; (b) received treatment, such as navigational cancer, and (c) paid KRW 9,200,000 to the Plaintiff regarding the treatment of psychotropic cancer; and (d) paid the Plaintiff KRW 9,20,000 to the Plaintiff.

2) The non-party 3, who was an employee of the insurance company that was a party to the non-party 1, requested the defendant to verify whether the amount of the principal charges paid to the plaintiff is non-benefit under the relevant statute.

3) On March 14, 2014, the Defendant issued a disposition against the Plaintiff to confirm that the amount of KRW 9,200,000 of the antiamcamcamcaming cost administered with Nonparty 1 is excessive, and to order the refund to Nonparty 1 (hereinafter “instant disposition”).

Although the criteria and method of treatment of the serum is to be applied to the blood transfusion in the form of oriental medicine, considering the traditional treatment method, it does not fall under the category of the existing pharmacological method by injecting drugs to the blood transfusion, and the application for new medical technology should be followed.

(c) Objections;

On April 24, 2014, the Plaintiff filed an objection against the Defendant (hereinafter “instant objection”), but the Defendant dismissed the Plaintiff’s objection on May 27, 2014.

Each entry and the purport of the whole pleadings in Gap's Evidence 1, 2, Eul's Evidence 1, 2 (including a Serial number; hereinafter the same shall apply) and the whole pleadings, which have no dispute with the basis for recognition.

2. Determination on this safety defense

A. The defendant's assertion

The defendant is not an administrative appeal, and the period of filing a lawsuit is calculated regardless of whether the plaintiff's application was filed. Since the plaintiff filed the lawsuit of this case on August 21, 2014 after the lapse of 90 days from March 26, 2014, which became known that the disposition of this case was taken, the defendant asserts that the lawsuit of this case was filed after the lapse of the period of filing a

B. Determination

1) Relevant legal principles and relevant provisions

A) According to Article 20(1) of the Administrative Litigation Act, a litigation seeking revocation is instituted within 90 days from the date when a disposition is known. In a case where an appeal is filed, the period when the appeal is filed shall begin from the date when the authentic copy of the written judgment is served. In light of the legislative intent of promoting the stability and prompt confirmation of legal relations surrounding the disposition, etc. by limiting the period of filing a lawsuit seeking revocation, the term “administrative appeal” refers to a special administrative appeal (Article 4 of the Administrative Appeals Act) where a special administrative appeal procedure instead of the general administrative appeal is prescribed by other Acts as an exception to the general administrative appeal under the Administrative Appeals Act and its special nature, taking into account the expertise and peculiarity of the case (see, e.g., Supreme Court Decision 2013Du10809, Apr. 24, 2014).

B) Article 87(2) of the National Health Insurance Act provides that “Any person who is dissatisfied with the Defendant’s disposition on the assessment, etc. of costs of health care benefit and health care benefit may file an objection with the Defendant.” Article 88(1) of the same Act provides that “Any person who is dissatisfied with the decision on an objection may file a petition for trial with the Health Insurance Dispute Mediation Committee pursuant to Article 89.” Article 90 of the same Act provides that “Any person who is dissatisfied with the disposition of the Corporation or the Defendant, and any person who is dissatisfied with the decision on an objection pursuant to Article 87 or a petition for trial pursuant to Article 88 may file an administrative litigation as prescribed by the Administrative Litigation Act.”

2) Whether the special case applies to the filing period

In full view of the following circumstances revealed by adding the contents and purport of the above related Acts and subordinate statutes, it is reasonable to deem that the objection of this case is subject to special administrative appeal procedure as prescribed by the Administrative Litigation Act, which is a special administrative appeal procedure which is deliberated and decided by the Health Insurance Objection Committee, and even if it is not so, it is reasonable to view Article 90 of the National Health Insurance Act as a special provision for the period of filing a lawsuit in the case of filing an objection under Article 87 of the same Act. Thus, the period of filing a lawsuit for cancellation shall be calculated from the date the result of the objection

A) According to Article 87(2) and (3), Articles 88(1) and 90 of the National Health Insurance Act, and Article 20(1) of the Administrative Litigation Act, a person who intends to file a revocation lawsuit against a defendant’s disposition may file a revocation lawsuit without filing an objection or a request for adjudication under the National Health Insurance Act, or file a revocation lawsuit without filing an objection or a request for adjudication, or file a revocation lawsuit without filing an objection or a request for adjudication on a discretionary basis, and may file a revocation lawsuit immediately after voluntarily filing an objection.

Article 90 of the National Health Insurance Act provides that "A person who has an objection to a disposition made by the Corporation or the defendant, and a person who is dissatisfied with a decision on an objection under Article 87 or a request for adjudication under Article 88, may file an administrative suit in accordance with the Administrative Litigation Act." ① The above provision deals with the same time when a decision on an objection has been made as to whether it is possible to bring an action for cancellation or when a decision on an appeal has been made in accordance with the Administrative Litigation Act. ② In order to bring an action for adjudication, an objection must be necessarily filed; ② in case of a request for adjudication after filing an objection, even though the special case period for filing an action is applied under Article 20(1) of the Administrative Litigation Act, if an objection is filed, it would normally result in unreasonable results in light of the fact that the special case

B) The nature of the objection of this case: (1) The objection of this case is prescribed in the National Health Insurance Act. (2) The defendant establishes an objection committee in order to efficiently perform the affairs of disposition on the objection of this case. The objection committee is composed of 25 members including one chairperson. The meetings of the objection committee are held when a majority of the members consisting of 6 members designated by the chairperson and the chairperson, and pass a resolution with the consent of a majority of the members present at the meeting (see Articles 53, 54, and 55 of the Enforcement Decree of the National Health Insurance Act).

In light of the above defendant's status, the duties and the organization of the objection committee, etc., the National Health Insurance Act seems to have established the objection system in this case as it is particularly necessary to consider the expertise and peculiarity of the case.

3) Whether the period for filing a lawsuit is expired

On April 24, 2014, the Plaintiff filed an objection against the instant disposition against the Defendant on April 27, 2014, but was dismissed on May 27, 2014. As seen earlier, the Plaintiff filed the instant lawsuit on August 21, 2014, which is apparent that the period of 90 days has not elapsed from that date, and thus, the instant lawsuit complied with the said period. Accordingly, the Defendant’s allegation is without merit.

3. Whether the instant disposition is lawful

A. The plaintiff's assertion

Blood domination is a “health insurance act’s benefit, non-benefit list, and relative point value of benefits” (Notice of the Ministry of Health and Welfare No. 2010-123, hereinafter “Notification of the Ministry of Health and Welfare”) publicly notified by the Ministry of Health and Welfare. Thus, the instant disposition based on a different premise is unlawful.

(b) Relevant statutes;

Attached Acts and subordinate statutes, etc. shall be as listed.

C. Facts of recognition

1) The definition, history, etc. of the pharmaceutical beverage

A) Definition: Pedcinging is a single medical practice that maximizes the effects of medicine and sediment by inserting or inserting the drugs extracted from herb, based on the sclosion theory, which is the theory of adjudication of successful bid, which is the theory of oriental medicine’s own closion. Pedclosion is a kind of the new closion method combining the Bedclothe and the Pharmaceutical Products Act, which is a combination of the Bedclothe and the Pharmaceutical Products Act. The Bedclothe method is based on the theory of adjudication of successful bid, and the prescription is based on both the theory of adjudication of successful bid and the sclosion. While taking the process of the procedure, the selection of medication is mainly based on the theory of adjudication of successful bid, and the selection of the treatment part is the unique technology of oriental medicine developed into science and technology and medical devices.

B) History: Around 1967, the paper was introduced into the Korean medical academic world to writing on the pharmacological law in the "Successful Bidding 1 and 2", and the term "herbalmism" was used in full scale. The summary is being studied and developed in countries where the Korean Medical Treatment Act is growing, such as Korea, China, Japan, etc., and the Korean Medical Care Association was established on August 26, 1990 in Korea.

C) Characteristics and principles: If the existing Bedcing Act provided treatment of a disease by transmitting a physical stimulation through bid and light blood linked to books and records, the pharmacological is used as an additional treatment method to add the chemical saculic saculic sacacacacacacacacacacacacacacacacacacacacacacacacacacacacacacacacs, etc.

D) The difference between pharmacological and injection

A doctor of a herb doctor who, as a result of an autopsy or examination on the basis of climatic cliffic cliffic cliffic clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clific clif

E) Current status of education: A medical college has provided regular education related to pharmacologically from around 1995.

2) Definition, method, history, etc. of surgery

A) Definition and history: Blood domination (here, having been injected directly into blood domination until now, and ordinarily, has been introduced into mountain circination) is an act of injecting drugs extracted by staticly in mountain ginseng, etc. into beer for disease and treating diseases. Mountain circination is an act of inserting a certain quantity into beer (which is limited to beerercination in mountain circination) and mountain circination is introduced as “hercination extracted from mountain or mountain circination ginseng, which is first used as a principal method of treatment for the first time in Korea.”

(b) Academic significance: Blood beercincincincincincincincincincincincincincincincincincincincincincincincincincincincincincincincin

3) Details of the instant public notice

A) Around January 2001, medicine was subject to medical care benefits under the National Health Insurance Act [10/100 items for which one’s own burden (the items corresponding to benefits cannot be received at will and the amount to be paid to the patient is determined as non-benefit items)]. Since January 2006, medicine was converted into non-benefit items.

B) The subject of the reimbursement for the royalty for the oriental medicine treatment as set out in the instant notice is 15 items, including “the climatic climatics, internal climatics, non-river mouths, climatics, internal climatics, ebbrates, investment methods, electronic bed, electronic bed, rashing, drackscopic, powder bed, bed, bed, bed, bed, ebscopics, bed, ebscopics, bed, ebscopics, bed, ebscopics, ebscopics, and Onnuri Auction Act.”

3) Interpretation of the Ministry of Health and Welfare

On July 26, 2013, the Ministry of Health and Welfare sent a reply with respect to the Gangnam-gu Medical & Pharmaceutical Affairs-22076 cases as follows:

As to whether an act of medication of mountain drugs with scambry in the table included in the main text of this Act is medical practice of an oriental medical doctor (here, herb doctor’s assertion of cambalination) - The Medicine Act, based on the sclosion theory of oriental medicine, is an oriental medical practice that enables oriental medical doctors to perform as a method that maximizes the effects of medicine and sediment by inserting the affected amount extracted from oriental medicine into pressure points, successful bid, and sclosion points, etc. on the basis of the sclosion theory of oriental medicine, and is academicly distinguishable from the act of injection, such as clodrosis, etc. - In addition, it is interpreted that an oriental medical doctor’s injection in closion which is not in accordance with the oriental medicine principle cannot be deemed a medical practice within the scope of license (see, e.g., Supreme Court Decision 201Do

4) Interpretation of the Korean Medical Association

A) The “Revision to Classification of Korean Standard Medical Practice” prepared by the Korean Medical Association around November 2008 is indicated as the “Mere Classification: Pharmaception, mid-classification: Pharmaception, small-scale classification: Pharmaception, small-scale classification: Pharmaception, Cheongneutaction, and maceptionaception.”

B) The Korean Medical Association prepared around October 2013 by the Korean Medical Association (hereinafter “Korea Medical Association”) on the standardization of the classification system by non-benefiting items and the development and research of the act definition, “the development and research of the act definition” is indicated in the type of non-benefiting act (malutism: emergency disease, acute dyephism disease, chronic expendable disease, chronic expendable disease, subject: Macro, pacsis, and Cheongne).

C) On December 10, 2013, the Korean Medical Association sent a reply to the request for opinion on the concept of blood transfusion among the classification of successful bidders to the effect that “male and blood is a concept that includes modern blood sources, which is used as a subject and method of treatment in oriental medicine, and is included in the meaning of the successful bid.”

(In fact that there is no dispute, Gap's 4, 5, 6, 7, 9, 10, 13, 23, and Eul's 4 and 5, the purport of the whole entries and arguments

D. Determination

1) In full view of the following circumstances revealed by adding the purport of the argument as a whole, it is reasonable to view that the above recognition of the above facts is a treatment method developed in the pharmacological, which is a non-benefit item listed in the instant notice, but it cannot be deemed that it is included in pharmacological, as there is an essential difference in the subject matter of surgery, treatment quantity, principle, efficacy, etc., and thus, it is not deemed that it should be separately recognized stability and effectiveness through the procedures for assessment of new medical technology, etc. (in relation to the serum surgery, it is reasonable to view that the stability and effectiveness should be recognized separately). Accordingly,

A) The notice of this case: According to the notice of this case, the pharmacological is classified as non-benefit items, but the concept and item of pharmacological is not specified.

B) The difference between medicinal dyscule and dyscule (as for dyscule, on the premise of bedclothes method)

(1) In ordinary cases, medicinal surgery is defined as “here-medical practice that maximizes the effect of aggression and medicine by inserting or inserting the clibs, etc. extracted from medicinal medicine on the part of the human body, such as pressure points, successful bid, and light blood points, based on an adjudication of successful bid theory, which is the theory of oriental medicine’s unique bedclothes.” The medicine therapy is based on the principle that injects it into the part of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body of the body.”

(2) However, in light of the fact that: (a) the description of evidence No. 7 alone cannot be deemed as having been included in the subject of bed; and (b) there is no material that there is the effect of bedclothesis on blood (not included in the subject of bedying); and (c) the blood bed in bedying surgery only functions as the mobile passage of drugs extracted from cryp, mountain ginseng, etc., and the blood bedying surgery seems to be a procedure that has no effect of bedyping, unlike the pharmacological, or is very weak, and only maximizes the effect of drugs.

(3) Therefore, it can be said that there is a difference between the following parts: (a) pharmacological and clothesis changes in the place of surgery (i.e., clothesis, blood transfusion, etc.; clothesis); (b) efficacy-generating mechanism (inclothesis: combination of the effect of bedclothes and drugs; and (c) clothesis; a single drug effect) and the bilateral essential part.

C) The scope, etc. of pharmacological, etc.: ① Pharmacologic was registered on or around January 1, 2001 under the relevant provisions of the National Health Insurance Act, etc. Accompact is a treatment method developed and developed thereafter. ② Pccompact, which is a cryposis, was developed on the basis of experiment results to maximize the treatment effect by inserting cryp, etc., which is not all the drugs extracted under the oriental medicine principle, and by inserting it into cryp, which is not an ordinary crypump (other than mountain culpine, the procedure of directly injecting it into culpine seems to be currently nonexistent). In light of the exceptional treatment method for administering culpine, etc., it is difficult to view that the Medical Treatment Act that injecting it into culp is a treatment method planned to be registered in the instant notification.

D) The purport of Article 2 subparag. 2 of the Regulations on the Evaluation of New Health Technology: The purpose of the Regulations on the Evaluation of Health Technology is to change the purpose of use, target of use, method of treatment, etc. of the health technology evaluated as new health technology, which the Minister of Health and Welfare deems necessary to assess the relevant health technology. Therefore, even if the climatic surgery is an exceptional treatment method that changes the method, principle, etc. of the existing climatic surgery, and as seen earlier, it is necessary to separately assess the new health technology in light of the development process, etc. of the climatic surgery.

E) Other: A theoretically, it is possible to administer a pharmacological surgery, and the treatment method by which it is enforced in China, Japan, etc., and even if it is written in the form of pharmacological surgery in various documents prepared by the Korean Medical Association, it cannot be deemed that the surgery by which it is non-benefit is included solely on such grounds.

2) Therefore, the instant disposition is lawful on the same premise.

3. Conclusion

Therefore, the plaintiff's claim of this case is dismissed as it is without merit. It is so decided as per Disposition.

[Attachment]

Judges Happon (Presiding Judge)