209No1791 Fraudulent

1. Ma○○○ (xx -xx xxx) and intentions;

Residential leisure 00 dong-dong

Standard place of registration: 00,000 square meters

2. 김□■ ( xXXXXX - XXXXXXX ), 병원원무과장

A 00 - 000 - Dong-ho-ho-ho-ho-ho-ho-ho

Gwangju Dong-dong-gu 00 Dong-gu - Do-

Defendants

Park Tae-gi

Law Firm Barun Law Firm (private ships for Defendant Ma○○)

Attorney Park Jong-jin, Lee Jin-jin

Attorney Kim Young-deok (Korean Office for Defendant Kim Young-chul)

Gwangju District Court Decision 2009Kadan457 Decided July 23, 2009

December 10, 2010

The judgment of the court below is reversed.

Defendant 1 is punished by a fine of KRW 7,00,00, and a fine of KRW 5,00,00, and a fine of KRW 00.

In the event that the Defendants did not pay each of the above fines, the Defendants shall be confined in the Labor House for a period of 50,000 won converted into one day.

To order the Defendants to pay an amount of money equivalent to the above fine.

1. Summary of grounds for appeal;

In light of the various circumstances of the instant case, the sentence sentenced by the lower court against the Defendants (a fine of KRW 7 million, and a fine of KRW 5 million: a fine of KRW 5 million) is too unreasonable.

2. Ex officio determination

A. Ex officio determination on changes in indictment by the prosecutor

Before determining the grounds for appeal by the prosecutor, the prosecutor applied for the amendment of the indictment to "235 won" in 205, 330 won in 2006, and 340 won in 207, which came into existence on the seventh trial day of the trial of the case, and since this court permitted this, this part of the judgment of the court below cannot be maintained. Furthermore, since this part of the judgment of the court below and the remaining criminal facts found guilty constitute concurrent crimes under the former part of Article 37 of the Criminal Act, the court below rendered a single sentence on the ground that the whole of the judgment of the court below cannot be maintained.

B. Ex officio determination on the Defendants’ assertion

After the deadline for submitting the statement of grounds for appeal, the Defendants asserted mistake of facts on the trial date as follows, in turn, shall be examined.

(1) As to paragraph (1) of the crime in the judgment below, the Defendants first asserted that (A) with respect to the main feed part of the medical expenses for which the Defendants acquired, the Defendants did not separately prepare a treatment slip describing the treatment results according to the doctor's prescription, and that the nurse or nurse (hereinafter referred to as the " nurse, etc.") did not enter the above part of the medical records based on the medical records stating the treatment details and prescription. (The above hospital's nurse, etc.") 'Tket' (as a camera where the above hospital's nurse, etc.'s nurse, etc. discharged the patient for convenience, the above Tket will all discard the above Tket when the patient discharged, and the nurse, etc. did not enter the above part of the medical records into force on the ground that the nurse, etc. did not actually take care of the above hospital based on the prescription. Thus, the court below determined that the above hospital did not take care of the above part of the medical records.

In light of the above records, the above hospital's nurse, etc. stated the patient's condition and doctor's miscker's treatment contents such as injection, etc., and stated that the above hospital's nurse, etc. reported the patient's miscker's medical treatment records and recorded them in the nursing record. The defendant YO also stated that the police officer stated the same as the above Kim Mana, while considering the police's statement and the prosecutor's statement at the police and the prosecutor's office's office, the above hospital's evidence duly investigated in the court below and the trial court, without any confirmation as to whether it was actually being taken into action against the patient as stated in the medical records, it is concluded that the above hospital took effect all as stated in the medical records, and accordingly, claims insurance money from the insurance company based on the above records that the nurse, etc. did not take injection as stated in the doctor's miscker's miscker's medical records, but it is difficult to say that the above hospital's medical records were executed during the prescription.

Therefore, the court below which found the defendant guilty of calculating the amount of fraud of the main feed based on the nursing record book is justifiable. Therefore, the above argument by the defendant is without merit even after examining it ex officio.

(B) Next, the Defendants asserted that the instant hospital did not separately prepare a meal ledger since February 2007, because all the inpatients had taken measures to provide meals at the hospital after the Defendants got involved in the food expenses in the name of the medical expenses acquired by the Defendants. This part of the facts charged argues that the Defendants calculated the amount of fraud by deeming that the food ledger was provided to the patients only when there exists a meal ledger.

However, according to the evidence duly adopted and examined by the court below and the court below, this part of the amount of fraud is calculated only when the patient hospitalized in the hospital of this case did not live in the sick room due to discharge, etc. Thus, the above argument by the defendants also is without merit. (C) The defendants asserted that this part of the crime of fraud was calculated based on the judgment of the court below and the court below, although this part of the crime of fraud was committed by the hospital of this case, with respect to the Egyptian (water treatment) of the medical expenses acquired by the defendants, the Egyptian (water treatment) of this case directly performed by the hospital of this case after the physical clinic return to Byungdong, and the management and employees only tried to move the physical therapy machinery.

그러나 ◈▲▲의 경찰 진술을 비롯하여 원심 및 당심에서 적법하게 채택하여 조사한 증거들에 의하면, 위 병원에서 오○이라는 관리과 직원이 물리치료사가 아님에도 표층열 물리치료를 시행한 사실을 인정할 수 있다 할 것이므로, 피고인들의 위 주장 역시 직권으로 살펴보아도 이유 없다 . ( 라 ) 끝으로 피고인들은, 피고인들이 편취한 진료비 명목의 금원 중 투약료와 관련하여, 피고인 임○이 이 사건 병원 건물 맨 윗층에 거주하였기 때문에, 그가 퇴근한 후 위 병원의 간호사 등이 의약품을 조제한 경우에도 이는 피고인 임○○의 지시에 따른 것이어서 피고인 임○○ 자신이 직접 의약품을 조제한 것으로 보아야 할 것임에도, 이 부분 공소사실은 피고인 임○○의 퇴근 후 간호사 등이 약을 조제한 경우를 무면허 의약품 조제행위로 잘못 판단하고 이 부분 편취액을 산정하였다고 주장한다 .

However, the 'preparation of Pharmaceutical Affairs Act' is a specific usage by mixing two or more medicines or sharing one medicine into a certain quantity according to a specific prescription.

In cases where a doctor directly prepares medicine for the purpose of treating or preventing a specific disease of a specific person (Article 2 subparag. 11 of the Pharmaceutical Affairs Act) and exceptionally permitted a doctor to prepare medicine under the Pharmaceutical Affairs Act, even if a doctor allows a nurse or an assistant nurse to prepare medicine by mixing the medicine, it may be deemed that the doctor directly prepares the medicine if the doctor practically uses a nurse, etc. by mixing the medicine. However, if the doctor is able to legally evaluate "the act of preparing medicine by a nurse, etc. according to the doctor's instructions" as "the act of preparing medicine by the doctor's own", the doctor actually directs and supervises the preparation of medicine by the doctor, i.e., the number of patients in the medical institution, the location of the dispensary, the type and efficacy of the medicine to be used, etc., and it is recognized that such direction and supervision could have been practically possible in light of the above medical doctor's instruction and supervision, and even if the doctor did not direct and supervise the patient within the scope of the above medical instruction and supervision by the doctor, etc. (see Supreme Court Decision 200Do416, supra.).

The Defendants asserted to the effect that the Defendants made a substitute claim for the use of DNA medication, even though they did not use any injection system, that they did not constitute fraud, since they did not make a false claim for the use of DNA medication, even though they did not use the injection system. This part of the facts charged also asserts to the effect that it does not constitute fraud.

살피건대 피고인들이 제출한 자료만으로는 피고인들이 실제로 디페인 주사제 대신 베타손 또는 피록시캄 주사제를 사용하였다고 볼 만한 자료가 없을 뿐 만 아니라 , 가사 피고인들이 위와 같이 대체청구를 하였다고 하더라도, 실제로는 베타손 또는 피록시캄 주사제를 사용하였음에도 디페인 주사제를 사용하였다고 청구한 것은 허위의 청구로써 피해자 □△△△공단, ♥ 공단 등에 대한 기망행위에 해당한다고 할 것이므로, 이 부분 공소사실 역시 사기죄로 인정된다고 할 것이어서, 결국 직권으로 살펴보아도 피고인들의 위 주장은 이유 없다 .

(3) Judgment as to the crime No. 3 at the time of original adjudication

Since the defendants thought that it was an unrecognized subject of medical care without knowing that it was the subject of medical care benefits, the defendants asserted that the defendants did not have any intention to commit fraud in this part.

살피건대, 다년간 의사로서 또는 병원 원무과장으로서 근무하여온 피고인들이 정맥유지침이 요양급여 대상인지 알지 못하였다는 변소는 쉽게 납득하기 어려울 뿐 만 아니라 정맥유지침이 환자들에게 수액제를 투여할 때마다 이용되는 매우 빈번히 사용되는 의료기구라는 점에서 피고인들로서는 정맥유지침이 요양급여대상에 해당하는지 여부를 미리 알아보아야 할 의무가 있다고 할 것인 점, 피고인 임○○의 처이자 위 병원의 보험금 청구 업무에도 관여하였던 박♥①이 경찰에서 정맥유지침이 환자에게 그 비용의 80 % 는 부담시켜서는 안되는 항목이라는 것을 알았다고 진술한 점 등을 종합하여 보면, 피고인들은 정맥유지침이 요양급여 대상이라는 점을 알았거나 적어도 요양급여대 상일수도 있다는 점을 알았으면서도 이 부분 공소사실 기재와 같이 이를 임의로 비급여 대상으로 전환시켜 환자들로부터 그 비용을 전액 지급받았다 할 것이어서, 피고인들에게 이 부분 사기죄에 대하여 적어도 미필적 고의가 있었음을 충분히 인정할 수 있다. 따라서 직권으로 살펴보아도 피고인들의 이 부분 주장 역시 이유 없다 . ( 4 ) 원심판시 범죄사실 제4항에 관한 판단

피고인들은, 이 사건 병원에서 환자들에게 삐콤헥사 주사제를 수액제에 혼합하여 투여한 것은 비타민결핍 및 소모성질환자가 아닌 환자들을 상대로 하여 단순한 예방목적 ( 영양공급목적 ) 으로 투여한 것이고, 이러한 경우 삐콤헥사 주사제는 비급여대상에 해당하는 것이므로 이 사건 병원에서 환자들로부터 삐콤헥사 약제비 및 이에 대한 수기료를 지급받은 것은 정당하다 할 것이어서, 이 부분 공소사실은 사기죄에 해당하지 아니한다고 주장한다 .

살피건대, 원심 및 당심이 적법하게 채택하여 조사한 증거들에 의하면, 삐콤헥사 주사제는 비타민결핍 및 소모성질환에 사용할 경우 요양급여 대상에 해당하는 사실, 그런데 피고인 임○○은 이 사건 병원의 환자들이 비타민결핌 및 소모성 질환으로 삐콤헥사의 처방이 필요한지 여부에 상관없이 환자들에게 이를 고지하지 아니한 채 예방목적 ( 영양공급 ) 이라는 명목으로 일률적으로 삐콤헥사 주사제를 처방하고 환자들로부터 삐 콤헥사 1개당 1, 000원씩 지급받은 사실을 인정할 수 있다 .

그런데, 요양기관이 치료행위를 하고 그 비용을 징수함에 있어서는 요양급여기준과 진료수가기준에서 정한 기준과 절차에 따라야 하는 것인바, 피고인들의 주장과 같이 이 사건 병원의 환자들이 대부분 비타민결핍 및 소모성질환을 가지지 않은 환자들이라면 위와 같은 환자들에게는 그 질병의 치료를 위하여 특별히 삐콤헥사 주사제의 처방이 필요하지 않았다 할 것이므로, 피고인들이 위 환자들로부터 단순 예방목적 ( 영양 공급목적 ) 으로 주사제를 투여한다는 것에 대해 동의를 받지 아니한 이상 특별히 처방할 필요가 없는 약제를 환자들에게 투입하고 그에 대한 비용을 지급받은 피고인들의 위 행위는 환자들에 대한 묵시적 방법에 의한 기망행위에 해당한다 할 것이고, 이와 같은 경우에도 환자들로부터 지급받은 금원 중 적어도 삐콤헥사 주사제가 급여 대상에 해당되었을 때 환자들이 부담하여야 할 본인부담금 부분을 초과하는 부분은 편취액에 해당된다고 할 것이어서 이 부분 공소사실 기재 편취액이 모두 사기죄에 해당한다는 점은 변함없다. 따라서 이 부분 공소사실에 관한 원심판결에 판결에 영향을 미친 사실오인의 위법이 있어 보이지 아니하므로, 직권으로 살펴보아도 피고인의 위 주장도 이유 없다 .

3. Conclusion

Therefore, the judgment of the court below is reversed without examining the defendants' assertion of unfair sentencing, on the grounds of the above ex officio reversal, and it is again decided as follows.

Criminal facts and summary of evidence

In addition to the change of "205, 3306, 340 won, and 340 won in 2007," the summary of the facts constituting the crime acknowledged by the court below and the summary of the evidence is as stated in each corresponding column of the court below's judgment. Thus, it is cited as it is in accordance with Article 369 of the Criminal Procedure Act.

Application of Statutes

1. Article relevant to the facts constituting an offense and the selection of punishment;

Articles 347(1) and 30 of the Criminal Act (Selection of Fines)

1. Aggravation for concurrent crimes;

Articles 37 (former part), 38 (1) 2, and 50 of the Criminal Act

1. Detention in a workhouse;

Articles 70 and 69(2) of the Criminal Act

1. Order of provisional payment;

Article 334(1) of the Criminal Procedure Act

In light of the fact that the reason for sentencing is in charge of a serious social responsibility to prevent the safety and health of the lives and body of the people, it is necessary to take a social responsibility based on a higher ethical awareness and awareness of vindication. In light of the fact that most of the doctors who faithfully treated the people due to the above crime of the Defendants may be suspected of engaging in the same conduct, and that in the case of receiving insurance money from an insurance company, national health insurance, etc., it ultimately results in damage to the majority of the policyholders, it is reasonable to punish the Defendants corresponding thereto.

However, in light of all the sentencing factors indicated in the records of this case, including the following facts: Defendant YO was a primary crime; Defendant Kim Man was sentenced to a fine due to a violation of the Road Traffic Act around 1992; there was no criminal record; Defendant YO does not seem to have been involved in administrative affairs such as a claim for medical expenses; and Defendant YO did not appear to have been involved in administrative affairs such as a claim for medical expenses; and Defendant YO returned the amount acquired by deception to the victim insurance companies and agreed to do so, etc.

Judges Park Jong-chul et al.

Judges Mobileho

Judges Yoon Jae-sung