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본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
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(영문) 서울고등법원 2015.01.23 2013누1753
요양급여비용환수결정취소
Text

1. The judgment of the court of first instance is modified as follows.

On February 23, 2012, the Defendant provided medical care benefit costs to the Plaintiff on February 23, 2012.

Reasons

1. The Plaintiff, as a dentist, established a “Cental clinic” (hereinafter “instant medical clinic”), which is a medical care institution in Seocho-gu Seoul Metropolitan Government, and performed medical treatment.

In accordance with Article 84(2) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 2011; hereinafter “National Health Insurance Act”), the employees of the Defendant-affiliated field investigation team (hereinafter “employee of the Defendant-affiliated”) conducted an on-site investigation on medical benefits and medical benefits for the period from November 1, 2008 to November 30, 209 (hereinafter “instant investigation”) with respect to the instant member from January 25, 2010 to January 29, 201.

In the investigation process of this case, employees belonging to the defendant examined whether part of the patient was actually treated or not, and prepared a list of the other patients except for those patients who confirmed that the patient was not 245 patients, such as family members, relatives, and relatives, and family members, who confirmed that the patient did not collect their own charges due to their family members, relatives, and family relations, and that there was a high probability that the contents of the report do not coincide with the medical records of this case and the daily business report (the ledger for receipt of personal charges, hereinafter referred to as the "receiving register") (not recorded in the collection ledger) by comparing them with the medical records of this case.

On January 29, 2010, employees belonging to the Defendant had the Plaintiff re-examine the list prepared as above. At the Plaintiff’s request, 17 patients were additionally deleted (the Plaintiff’s husband D, a dentist at the Plaintiff and the instant member, stated that “The details of the above list are the same as those of the actual medical treatment, and that the number of persons who were selected without being verified the details of the above list are the same” at the end of the above list, and signed by the Plaintiff.

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