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(영문) 서울행정법원 2019.04.18 2018구합1862
요양급여비용 환수처분 취소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Details of the disposition;

A. On December 8, 2017, the Seoul Southern District Court (2017Gohap349, 371, 379, 413 (Consolidation), and 433 (Consolidation) found the Plaintiff guilty of violating the Medical Service Act, violating the Act on the Punishment, etc. of Specific Economic Leave (Fraud), and sentenced the Plaintiff to one year and six months of imprisonment and three years of suspended execution. The above judgment became final and conclusive around that time because the Plaintiff and the Prosecutor did not appeal.

1. No person, other than doctors, dentists, oriental medical doctors, midwifes, the State or local governments, medical corporations, nonprofit corporations established under the Civil Act or any special Act, quasi-governmental institutions established under the Act on the Management of Public Institutions, local medical centers established under the Act on the Establishment and Operation of Local Medical Centers, or the Korea Veterans Welfare and Healthcare Corporation established under the Korea Veterans Welfare and Healthcare Corporation

On or around September 2010, in the building located in Sejong Special Self-Governing City, B lent the name of the incorporated association D (hereinafter “instant association”) and the Plaintiff recruited to establish a medical institution under the name of the instant association.

On October 7, 2010, the Plaintiff reported the establishment of E-wons (hereinafter “instant member”) under the name of the Association at the Si/Gun/Gu Public Health Center for Sejong Special Self-Governing City. From around that time to May 2, 2014, the Plaintiff equipped with medical facilities in the instant building and hired medical doctors and nurses to conduct medical treatment against patients.

Accordingly, the plaintiff and B conspired to establish a medical institution without being entitled to establish a medical institution.

2. The Plaintiff and B in violation of the Act on the Aggravated Punishment, etc. of Specific Economic Crimes (Fraud) filed a claim for medical care benefit costs with the Health Insurance Review and Assessment Service as if they were lawfully established and operated under the Medical Service Act, even though they were illegally established in a medical institution like the above 1.

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