Plaintiff (Law Firm Barun, Attorney Park Jae-hwan, Counsel for the plaintiff-appellant)

The Minister of Health and Welfare (Attorney Park Jong-chul, Counsel for defendant-appellant)

November 20, 2013

1. The plaintiff's claim is dismissed.

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

The Defendant’s disposition of imposition of the penalty surcharge against the Plaintiff on April 8, 2011 (hereinafter “instant disposition”) shall be revoked.

1. Basic facts and circumstances of dispositions;

A. The Plaintiff is a medical specialist with childbed who opened and operated the “○ Women’s Council member” located in Eunpyeong-gu Seoul ( Address omitted), Seoul (hereinafter “the instant Council member”).

B. The Ministry of Health and Welfare amended the detailed statement on the criteria and method for the application of the Medical Care Benefits Act as of December 20, 2005 by the Ministry of Health and Welfare No. 2005-101 on December 20, 2005, which is the Ministry of Health and Welfare’s notice, to increase the number of gold operation. As a result, a situation where the health insurance finance becomes worse occurs, the Ministry of Health and Welfare revised the above notice as of January 23, 2007 in order to prevent the proliferation of improper gold operation and to promote the efficiency of the health insurance finance (hereinafter “instant notice”).

In addition to the criteria for recognition, it is recognized that the main substance of the Table Nos. 356, which is the detailed approval of the title of the Table Nos. 356, using artificial tape for the approval criteria for the use of artificial tape for the operation of 356, is that the head head of the pyocH2O is verified by the epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic epidemic pactic pactic pactic pactic pactic pactic pactic pactic pactic pactic pactic pactic s

(i) Air-proof pressure;

Note 2) Leak pressure

C. On November 27, 2008, the Health Insurance Review and Assessment Service prepared the following guidelines for the method of measuring luminous pressure and required leakage pressure, for the purpose of preventing in-depth test results and inducing appropriate treatment due to the occurrence of unnecessary surgery as a result of an in-depth test since it was not conducted in a standardized manner as required by the instant notice (hereinafter “in-depth pressure test of this case”).

In the case of measuring the luminous pressure and humo pressure contained in the main text, the examination method (the Health Review and Assessment Service Review Guidelines of November 27, 2008) shall begin from the time when the luminous pressure or humo pressure and the humo pressure test starting from the time when the luminous pressure or humo pressure test began to run and from the time when the luminous pressure or the humo pressure began to run, and when the humo pressure or humoo pressure from humoculing is found to run, the examination shall be revised immediately to at least "0 (Zo)". In addition, the humo pressure test method shall begin from the time when the humo pressure or humo pressure test begins to run from the time when the humo pressure or humo pressure from the time when the hum

D. From March 2, 2010 to April 4, 201 of the same month, the Defendant conducted a field investigation (hereinafter “instant field investigation”) on the details of the medical care benefit claim of the instant member, and discovered the fact that the instant member filed an unfair claim against 46 patients (the list is indicated as evidence B; hereinafter the same shall apply) using artificial tape in violation of the instant public notice, and collected excessive charges from the patients. On April 8, 201, the Defendant calculated a specific penalty surcharge in lieu of the Plaintiff’s disposition of business suspension and penalty surcharge pursuant to Articles 85-2(1) and 85(1)1 of the former National Health Insurance Act (amended by Act No. 11141, Dec. 31, 2011; hereinafter the same shall apply) on December 1, 2007 to December 31, 2009.

1. Details of the ticket ○○ Unfair Requests included in the main text: 1. Claim for violation of the standards for recognition of the necessary gold operation using the artificial tape (28,785,082 won) - The necessary gold operation using artificial tape is recognized in cases where the main complex gold is verified due to the crypology loss or the main complex gold, and where the cryp pressure is less than 120ccH20,000, and all kinds of medical care expenses, such as operating fees, hospitalization fees, and anesthesia fees, are not payable but payable, but if the results of the examination do not meet the standards for recognition, the amount shall be stored and output by other examination results consistent with the standards for recognition; 1. 2. 2. 2. 2. 1, 879, 390-106 - 7. 7. 7. 80% of the total amount of the medical care benefit costs for non-permanent prescription; 3. 7. 5% of the total amount of the 3rd. 2. 97. -6% of the total amount of the 2.

E. The instant notice was amended as follows by the Ministry of Health and Welfare’s Notice No. 2011-144 on November 25, 2011 (hereinafter “after amendment”).

1. In the case of an operation using artificial tape 1. In the case of an operation using artificial tape 356, it is recognized as the case of an operation requiring an operation since the main mixed substance is confirmed as a result of the epidemology test of the epidemology, the amount or the amount of the pyotension loss is the main mixed substance. However, in the case of an examination of the epidemology of a doctor in charge of treatment, the following items shall be included and submitted along with the relevant examination results at the time of filing a claim for medical care benefit expenses. (a) 2.0 .- 2. other than the criteria for recognition, it is deemed that the effectiveness of the expenses is reduced and the purpose is more preventive than that of the treatment. (b) All kinds of medical treatment expenses (such as admission fees, narcotics and expenses for medical treatment, etc.) are not medical care benefits (non-payment).

F. On September 26, 2013, the Constitutional Court dismissed this part of the claim on the ground that the instant guidelines do not constitute the exercise of governmental power, and that the instant guidelines do not infringe on the doctor’s freedom of occupation, the right to life worthy of human dignity, and the right to health of patients. The instant guidelines are dismissed on the ground that the instant guidelines do not constitute the exercise of public power.

G. The term “urgical test”, which is conducted for the patients with urine, refers to all tests to be conducted with respect to the storage function and urine function of urine, including luminous and urine. Among this, the urgical test of this case is conducted by inserting the pipes connected with the urgical test device into the patient’s resistance and the urgical pressure and urgical pressure into the patient’s urgical test so that urgical pressure and urgical pressure can be measured. While the urgical test of this case, the urgical test of this case is conducted by the method that the urgical inspector dividess the urgical pressure and pressure of the urgical test device so that urgical pressure and urgical pressure can be measured, and then the urgical pressure and pressure of the urgical test at that time.

[Reasons for Recognition] Unsatisfy, Gap evidence Nos. 1, 4, 8, 12, Eul evidence No. 31, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The plaintiff's assertion 3)

1) unconstitutionality and illegality of the instant notice and the instant guide

The instant public notice and the instant guidance are unconstitutional and illegal for the following reasons. As such, the instant public notice and the instant guidance are deemed unlawful on the premise that the Plaintiff’s medical care benefit claim is lawful, based on the premise that the instant public notice and the instant guidance are unlawful.

A) Notice of this case

The notice of this case is to conduct a epidemia test of this case before conducting the epidemia surgery using the artificial tape. This is null and void as it infringes on the plaintiff's freedom of occupation, the right to property and the right to pursue happiness, and infringes on the patient's right to health, the right to property and the right to pursue happiness.

In addition, the public notice of this case recognized the fact-finding operation as medical care benefits only for a patient whose required leakage pressure is less than 120 cmH2O, and there is no medical basis for this, and the defendant itself recognized the illegality and deleted this requirement in the public notice after the amendment. Therefore, this part of the public notice of this case is unlawful.

B) The instant guidelines

Although the Health Insurance Review and Assessment Service does not delegate the authority to determine the scope and limit of health care benefit, it is unlawful to consider the instant guidelines prepared by the Health Insurance Review and Assessment Service as a standard for determining the illegality of the claim.

2) misunderstanding of facts

The Plaintiff performed a surgery using artificial tape only when the patient was determined to have a major symptoms of tension loss or pytension loss in accordance with the instant notice after conducting the epidemology test for the patient under the instant notice, or when the patient was determined to have less than 120ccH2O, not to have performed a surgery for the patient who does not fall under the above cases. Even if the Plaintiff claimed the expenses for benefits by attaching other patient’s examination results to the medical record, it is not because the pressure of leakage was measured more than 120ccH2O as a result of the epidemology test for the patient at issue, but it is inevitable for the Defendant to use another test result in order to avoid reducing the expenses for benefits based on the guidelines of this case. The Defendant cannot be deemed to have proved that the Plaintiff failed to prove that the Plaintiff claimed the expenses for benefits for the patient who violated the instant notice even if the leakage pressure exceeds 120ccH2O.

3) Failure to capture under Article 85(1)1 of the former National Health Insurance Act

Article 85 (1) 1 of the former National Health Insurance Act must be strictly interpreted. As such, it cannot be deemed that the above act of the plaintiff is included in the case where the plaintiff bears the costs of health care in the "speed acceptance or any other unfair means" as provided in the above provision. In addition, in comparison with the language of the above provision and the language of Article 52 (4) of the same Act, in order for the above provision to be applied, the health care institution should bear the costs of health care benefit to both the insurer and the subscriber by deceit and other improper means. Since the plaintiff did not unfairly require the subscriber to bear the costs of health care, Article 85 (1) 1 of the former National Health Insurance

4) The legitimacy of the claim for medical care benefits before disclosure of review cases

Even if the Plaintiff filed a claim for medical care benefit costs in line with the instant notice, etc., the Health Insurance Review and Assessment Service disclosed the cases of review of medical care benefit costs related to the fact-finding surgery on January 19, 2008, and thus, prior to that, the Plaintiff’s performance of the fact-finding surgery and the receipt of medical care benefit costs therefrom should not be viewed as an unfair claim, as it was conducted when there is no specific

B. Relevant statutes

It is as shown in the attached Form.

C. Determination

1) Whether the notice of this case and the guidelines of this case are unconstitutional or unlawful

A) Notice of this case

(4) In light of the above fact that the public health care benefit of this case is no longer necessary for the public health care benefit of this case to be recognized as a medical care benefit, it is clear that the public health care benefit of this case is to be implemented without any infringement of the right to health care benefit of this case. However, since the public health care benefit of this case is to prevent unnecessary gold operation and to give maximum benefits to the public with limited health care benefit, it can be acknowledged that the public health care benefit of this case is justifiable. (2) In order to achieve such legislative purpose, the public health care benefit of this case is no longer necessary for the public health care benefit of this case because the public health care benefit of this case is no longer necessary for the public health care benefit of this case because the public health care benefit of this case is no more than for the public health care benefit of this case. Such public health care benefit of this case is no more than for the public health care benefit of this case. It is also appropriate for the public health care benefit of this case to determine whether it is necessary for the public health care benefit of this case.

Then, we examine whether the notice of this case is unlawful for a patient whose required leakage pressure is less than 120 ccH2O subject to medical care benefits. According to the evidence Nos. 5-7, the Korea Industrial Science & Technology Association issued the Health Insurance Review and Assessment Service's medical validity of the required leakage pressure standard (120 ccH2O) of the notice of this case. It is weak for the Defendant to have no significant difference in the results of the operation of the required leakage in accordance with the degree of the required leakage pressure before the operation, and to not use the required leakage pressure as a single factor or to predict the results of the operation. According to the opinion of the Ministry of Health and Welfare, it is unreasonable for the Defendant to use the specific value of the required field prosecutor as an insurance standard, and it is not reasonable to consider the change of the medical pressure of the patient subject to health insurance as an inevitable point of view that it cannot be seen that the new medical pressure of the patient subject to health insurance cannot be seen that the new medical pressure of each of the above cases cannot be deemed to have been changed.

B) The instant guidelines

The guidelines of this case do not have a binding force that limits the method of the epidemian test of this case, as alleged by the plaintiff, since they were not enacted pursuant to the delegation of laws and regulations, it is not a binding force that restricts the method of the epidemian test of this case. However, if the plaintiff measure the epidemian pressure in a medically widely used manner, it is not an unfair claim even if the detailed method is contrary to the guidelines of this case. However, in the case of the disposition of this case, the detailed method that the plaintiff obtained the result of the epidemian test of this case does not comply with the guidelines of this case and it is a problem that the plaintiff distorteds the numerical value that the plaintiff used the result of another patient's inspection or measured. Thus, whether the guidelines of this case

2) Whether there is a mistake of facts

A) According to the Plaintiff’s statement No. 1-4 and No. 8-29 (including each number in the case of Nonparty 4) as to Non-Party 1’s results of the instant on-site investigation, the Plaintiff: (a) stored the value of the results of the instant 46 patients not falling under the criteria for recognition; and (b) claimed medical care benefits by printing out the results of the results of the instant 4 other than the results of the instant H examination; (c) the Plaintiff’s statement that “the results of the instant 46 patients were identical to those of the patients,” and “the results of the instant 1-6 patients’ oral inspection were insufficient to reproduce the symptoms and symptoms of the 4-H inspection; and (d) the Plaintiff’s statement that the results of the instant 4-H inspection were not consistent with the criteria for recognition of medical care benefits; and (e) the Plaintiff’s previous 2-H inspection were replaced by the results of the instant 3-H inspection without any other person’s consent to the Defendant.”

B) Although the Plaintiff’s medical records were compiled into the medical records, all the patients at issue were confirmed to meet the requirements of less than 120 cmH2O and performed the required amount operation. Thus, the Plaintiff asserts to the purport that the Defendant should prove that these patients did not meet the above required leakage pressure requirement. Thus, the burden of proving that the patient was paid medical care costs by murder, fraud or other improper means is the Defendant (see Supreme Court Decision 2008Du6981, 698, Sept. 11, 2008). However, the Plaintiff’s result of the examination that left another person’s medical records or made the result of the examination so that it was different in value from the actual results of the examination. As seen above, Nonparty 2 did not submit the inspection results for the purpose of meeting the requirements of less than 120 cmH2O from the police investigation, and thus, Nonparty 2 did not meet the above requirements of less than 120 m20 m20 m20 m2 patients.

3) Whether it is included in Article 85(1)1 of the former National Health Insurance Act

As seen earlier, insofar as the Plaintiff claims expenses as if they were not the subject of medical care benefits by manipulating the result of the epidemiological examination and claiming as if they were not the subject of medical care benefits, such act constitutes fraudulent or other unfair means. In addition, the Plaintiff asserts that in order to fall under Article 85(1)1 of the former National Health Insurance Act, all the insurer and the insured should bear medical care benefits. However, the necessity to punish unfair claims for medical care benefits through suspension of business or penalty surcharge, etc. lies in cases where both the insurer and the insured were conducted in an unfair manner (such as where the Corporation charges and the principal charges are claimed against the non-regular medical care act as if they were the subject of medical care benefits, or where the total amount of expenses are claimed against the insurer as if they were not the subject of medical care benefits, and as if they were the subject of medical care benefits, the insurer and the dependent’s dependent’s dependent’s dependent’s dependent’s dependent’s dependent’s dependent’s liability are not necessarily construed. In light of the meaning and meaning of Article 85(1)1) of the former National Health Insurance Act, the insurer and the insured’s dependent’s liability.

4) Whether the prior claim is improper on January 19, 2008

In light of the content of the instant public notice, although doctors who conduct a gold operation should know specific cases of examination, it does not seem to be able to conduct an operation in accordance with the instant public notice, and even before January 19, 2008, the Plaintiff already known the contents of the instant public notice, as seen earlier, manipulating the results of a epidemiologic test to claim medical care benefits in accordance with the instant public notice. Therefore, it cannot be the ground for exempting the Plaintiff from the responsibility of the Plaintiff on or before January 19, 2008 of the details of the Plaintiff’s claim for medical care benefits in violation of the instant public notice.

3. Conclusion

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

[Attachment]

Judges Lee Jin-hun (Presiding Judge)

Note 1) The term “Pves” means the pressure within the mine protection area. This is composed of the pressure of urine urine urines (urine urine urine urine urine urine urines), which is the pressure within the pure mine protection area, and the pressure of urine urines (urine urine urine urines), which is the pressure by means of urgical external force. At the same time, the term “ multi-way urgical urgical urgical urgical urgicals” normally used is calculated by the method of measuring the urgical pressure (Pveds) by the urgical urgic urgic urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical urgical.

Note 2) The term “emulsion” refers to the air-conditioning pressure at the time of the occurrence of an influent outflow of a riverine, and in the event of an influence of a riverine, it is the lowest pressure of an influence of an influence of an influence. In the event of an influence of an influence of a riverine, the lowest pressure of an influence of an influence is the pressure of an influence, which is the pressure measured in the event of an influent outflow and an influence (influent of an influent pressure) according to the method of inducing an influence. It is distinguished into VLPP (ValsLLLLLLLLL) which is the pressure measured when an influent outflow occurred.

3) The Plaintiff appears not to dispute the excessive collection of the Defendant’s charges among the instant dispositions.