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(영문) 서울행정법원 2018.09.20 2015구합82273
명단공표 대상자 확정처분 취소
Text

1. On December 12, 2015, the Defendant is subject to publication of the list of health insurance claims medical care institutions that the Plaintiff made with respect to the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is a herb doctor who establishes and operates a “Chanwon” in Daegu Suwon-gu B (hereinafter “Chanwon”).

B. On May 2013, the Defendant conducted a field investigation as to whether the medical care benefit cost of Hanwon was properly claimed (the period subject to investigation: from October 1, 2010 to March 2013; hereinafter “instant field investigation”).

C. As a result of the instant on-site investigation, the Defendant rendered a disposition suspending the operation of a medical care institution for 53 days (from June 8, 2015 to July 30, 2015) on the Plaintiff based on the “Article 98(1)1 of the National Health Insurance Act” as follows.

False claim for the number of 19,486,10 won: In the case of a person who has been partially 19,486,110 won, he/she shall be recorded in the medical records and recorded in the medical records and claimed medical examination fees, treatment, etc. as medical care costs.

D. In addition, on December 12, 2015, the Defendant notified the Plaintiff on December 12, 2015 that, upon deliberation by the Health Insurance Publication Deliberation Committee for the second half of the year 2015, a member of the instant Council, based on Article 100 of the National Health Insurance Act, was finally confirmed as a person subject to the publication of the list of false health insurance claims (from December 28, 2015 to June 27, 2016).

(hereinafter referred to as "disposition of this case"). 【No dispute exists, entry in Gap evidence Nos. 1, 3, 5, and 6 (hereinafter referred to as "legal number") and the purport of the whole pleadings.

2. Whether the instant disposition is lawful

A. On May 20, 2013, at the time of the instant on-site investigation, the assistant nurse D, a person in charge of receipt of the instant one Council member, prepared a confirmation document on the following facts and submitted it to the Defendant.

The patient shall be in charge of the receipt of the patient's internal duties, and shall record the name and the amount of receipt in the order of the internal duties in the receipt ledger.

The patient who actually fested on his day shall record and confirm all of the patients.

A patient list additionally stated on the following day shall be the principal.

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