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(영문) 대법원 2020.09.03 2015다230730
손해배상(기)
Text

All appeals are dismissed.

The costs of appeal are assessed against the Plaintiff.

Reasons

The grounds of appeal are examined.

1. As to the assertion of misapprehension of legal principles as to unjust enrichment (ground of appeal No. 1)

A. According to the National Health Insurance Act, medical care institutions shall make a request for review of medical care benefit costs to the Health Insurance Review and Assessment Service, and the request for review shall be considered as the claim for medical care benefit costs against the National Health Insurance Corporation (hereinafter “Corporation”), and the Health Insurance Review and Assessment Service shall immediately notify the Corporation and the health care institution of the details of the review, and the Corporation notified of the details of the review shall, without

(Article 47) and a person who is dissatisfied with a disposition taken by the Service on the expenses for insurance benefits may file an objection with the Service (Article 87), and a person who is dissatisfied with a decision on an objection may file an appeal with the Health Insurance Dispute Mediation Committee under the Ministry of Health and Welfare (Article 88), and may institute an administrative litigation

§ 90. (b)

According to the provisions on the payment and objection procedures of medical care benefit costs, the claim for medical care benefit costs to the Corporation by a medical care institution is a specific right by making a decision upon the request of the medical care institution, and it cannot be deemed that it promptly occurs under the National Health Insurance Act regardless of the decision of the Corporation.

Therefore, unless the decision on the payment of medical care benefit costs corresponding to the legal cause of the receipt of medical care benefit costs by a medical care institution is not revoked, the medical care benefit costs paid according to such decision cannot be deemed as benefit without legal cause, barring special circumstances such as the natural invalidity of the decision on the payment of medical care benefit costs. Moreover, the claim for return of unjust enrichment corresponding to the medical care benefit costs by the Corporation is not established (see, e.g., Supreme Court Decision 2013Du6541,

Examining the reasoning and records of the lower judgment in light of the foregoing legal doctrine, the Plaintiff’s medical care benefit cost of this case.

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