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(영문) 서울행정법원 2019.10.17 2018구합67114
업무정지처분무효확인
Text

1. The Defendant’s disposition of suspending the business of a medical care institution against the Plaintiff on September 21, 2017 is revoked.

2. The costs of lawsuit shall be.

Reasons

Details of the disposition

A. The Plaintiff is an oriental medical doctor who establishes and operates the “Chanwon” in Ulsan-gun B (hereinafter “instant oriental medical doctor”).

B. From March 23, 2015 to March 25, 2015, the Defendant conducted an on-site investigation on the current status, etc. of the claim for medical care benefit cost of the Plaintiff from February 2, 2012 to June 2012, 2012, and from October 2014 to December 2015 (the period subject to the investigation, total of eight months).

(hereinafter “instant on-site investigation”). Grounds for the instant disposition

1. double claim for medical care benefit costs after non-benefit medical treatment: 11,132,00 won (hereinafter “instant disposition ground”) shall be non-benefit medical treatment, etc., and even if the relevant expenses were collected from the winners as non-benefit, the medical examination fees, oriental medical treatment fees, etc. shall be claimed as medical care benefit costs;

2. Request for violation of standards for calculating medical examination fees: Medical examination fees for the preparation of overlapped drugs subject to non-payment of KRW 204,180 shall be deemed to be included in the overlapped price, and thus, it cannot be separately calculated, as medical examination fees are claimed as medical care benefit costs.

3. A claim for calculation of the amount of hot air conditioners' charges: 1,642,593 (1,642,593) may be calculated in cases where an oriental medical doctor conducted in a medical care institution, bedclothes, etc. and recorded the result in the medical records. However, even if the result was not stated in the medical records, calculation of the period for which medical care benefit is applied as a period for which medical care benefit is applied: The period subject to investigation - calculation of the period for which medical care benefit is suspended - the total amount of medical care benefit cost determined on December 6, 2012 to December 10, 2014 to January 8, 2015 (195,207,607, 12,938, 1101, 617, 2636.26 (1): The average average monthly amount of medical care benefit cost determined on the basis of the total amount of costs subject to investigation x 30% (unfair average amount of costs): The period subject to investigation x 10%) average average monthly amount (20%).

C. On September 21, 2017, the Defendant is an unreasonable method by the Plaintiff as follows.

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