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All appeals by the Defendants and the Prosecutor are dismissed.
Reasons
1. Summary of grounds for appeal;
A. In fact, misunderstanding of the legal principles and mistake of the Defendants (the Defendants) merely received hospital treatment as much as the necessary period according to the direction of the doctor in charge, without deceiving the victim insurance companies, and did not intend to commit the crime of defraudation of insurance proceeds.
B. The sentence of the lower court (two years of suspended sentence for each of the Defendants’ imprisonment with prison labor) is too uneasy and unfair.
2. Determination
A. Fact-finding 1) In a case where continuous observation by a medical personnel is required in relation to side effects or incidental effects of drugs which are very low in resistance to, or are administered by, a patient’s disease, where medication and food need to be continuously conducted, and thus, the patient’s pains rather inconvenience in treatment is caused, or where the patient’s condition is unable to cope with, or where there is a risk of infection, etc., the patient suffers from treatment while staying in the hospital. As such, according to all the provisions of the “Detailed Matters on the Standards and Method for Application of the Care Benefits”, the Public Notice of the Ministry of Health and Welfare (Public Notice of the Ministry of Health and Welfare), the patient’s stay in the hospital for at least six hours, and thus, the patient is treated under the observation and management of the medical personnel. As such, the patient’s symptoms, diagnosis and treatment of the patient, the details and circumstances of the patient’s behavior, etc., as well as the case where the patient’s substance does not need to be hospitalized.
The act of claiming insurance money by asserting that the insurance company satisfies the hospitalization period stipulated in the insurance terms and conditions without notifying the case of a long-term hospitalization, which is more necessary, constitutes a deception in fraud (see Supreme Court Decision 2004Do6557, Jan. 12, 2006).