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(영문) 서울행정법원 2019.05.02 2018구합72260
업무정지처분취소
Text

1. The Defendant’s disposition of business suspension against the Plaintiff on June 1, 2018 is revoked.

2...

Reasons

Details of the disposition

The Plaintiff is a medical corporation established and operated a C convalescent Hospital (hereinafter “instant hospital”) in Seo-gu Incheon on February 17, 2014.

Around October 2016, the Defendant conducted an on-site investigation (hereinafter “instant on-site investigation”) with regard to all matters concerning health insurance and medical benefits to the instant hospital, setting the investigation period from October 2015 to December of the same year, and from June 2016 to August 2016 (hereinafter “the investigation period”).

Total unreasonable amount: 20,599,240 won: 20,599,240 won; - The list of health insurance benefit and non-benefit table; and the list of benefit points in the third part of the relative value point of the care hospital of Part III of the third part of the relative value of the health insurance act, the relative value point, and the calculation guidelines [calculated Guidelines]

4. (e);

According to the differential hospitalization system based on the level of nursing personnel, the grade of nursing fees for the immediately preceding quarter shall be calculated based on the average number of nursing personnel (expenses of the number of nursing personnel for the immediately preceding quarter), who are engaged in nursing services for the number of patients, and the number of nursing personnel shall be determined based on the standards related to differential application of hospitalization fees for convalescent hospitals according to the level of securing nursing personnel in accordance with Article 2009-214 announced by the Ministry of Health and Welfare, and the number of nursing personnel shall be recognized as nursing personnel in the case of nurses who are exclusively in charge of nursing services for inpatients, but in the case of nurses, they shall be in charge of receiving, etc. from May 1, 2015 to July 8, 2016. In the case of nurses E, they shall report to the Plaintiff on the number of nursing personnel who are exclusively in charge of providing nursing services in high-frequency treatment rooms, etc. from May 1, 2015 to May 31, 2016, as a result of a field investigation conducted by the Defendant 28.

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