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(영문) 서울행정법원 2019.12.13 2018구합72086
업무정지처분취소
Text

1. All of the plaintiffs' claims are dismissed.

2. The costs of lawsuit are assessed against the plaintiffs.

Reasons

1. Details of the disposition;

A. The Plaintiffs jointly operate D Council members from Gangnam-gu Seoul building and fourth floor (hereinafter “instant Council members”).

B. From October 15, 2015 to October 20, 2015, the Defendant conducted an on-site investigation with respect to the instant member (a total of 36 months from September 2012 to August 20, 2015; hereinafter “instant investigation”).

At the time of the examination of the medical care benefit claim statement (No. 4) 3,897 items presented by the Defendant after non-benefit medical treatment provided by the Defendant, the Plaintiffs did not state any indication as to the medical care benefit claim in the remarks column, ① non-benefit medical treatment act, and received non-benefit medical expenses from the person who performed the non-benefit medical treatment, and then claimed medical treatment fees as medical care benefits. ② In the case of non-benefit medical treatment, the Plaintiffs indicated “△△” as to the case of claiming medical care benefits without receiving non-benefit medical care expenses from the person who performed the non-benefit medical treatment, and ③ as to the case of claiming medical care benefits without receiving medical care expenses from the person who received the non-benefit medical treatment, the Plaintiffs stated “△△△” as to the case of treating only the disease subject to the medical care benefits, along with the non-benefit medical treatment, and signed as to the case of claiming medical treatment fees.

(hereinafter referred to as the above, "the explanation explanation team" is the vindication of the case. (c)

On October 20, 2015, the Defendant’s employee in charge of the instant investigation conducted double claims for medical care benefit costs after the Plaintiff’s treatment subject to non-benefit: Medical examination fees, despite the fact that the Plaintiff, pursuant to Article 9(1) [Attached Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance, was conducted for cosmetic Purpose and for Stockholm injection, etc., and was collected from the winners as non-benefit.

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