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(영문) 부산지방법원 2017.06.01 2016구합22798
장기요양급여비용 환수결정처분취소
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. The Plaintiff established and operated the C Elderly Welfare Center (the maximum number of admitted persons, 29 persons, 2-19 persons, hereinafter “instant welfare center”), which is a sanatorium for older persons designated as a long-term care institution under the Act on Long-Term Care Insurance for Older Persons in Ulsan-gun, Ulsan-gun.

B. From March 28, 2016 to March 31, 2016, the Defendant and the head of Ulsan-gu Ulsan Metropolitan City: (a) conducted an on-site investigation into the instant welfare center; and (b) determined that the Plaintiff unduly claimed and received expenses for benefits of KRW 56,537,650 in total in violation of the criteria for the assignment of human resources and the criteria for additional assignment of human resources as follows.

◆ 인력배치기준 위반 간호조무사 D이 2015. 6. 12.과 2015. 6. 14.에 09:00부터 13:00까지만 근무하고 2015. 6. 13.에는 근무하지 않았음에도 위 일자 모두 09:00부터 18:00까지 근무한 것으로, 원고가 2015. 5.과 2015. 10.에 간호조무사로 근무하지 않았음에도 근무한 것으로 각 근무시간을 허위로 신고하여 인력배치기준을 위반하였음에도 급여청구시 감액조정하지 않고 15,416,570원을 부정 청구하여 지급받음 ◆ 인력추가배치 가산기준 위반 조리원 E이 2015. 3. 2. 입사하여 격일로 출근하였음에도 매일 출근한 것으로 근무시간을 허위로 작성하여 2015. 4., 2015. 6.부터 2015. 11.까지, 2016. 1., 2016. 2. 인력추가배치, 필요수 인력배치, 야간직원 배치강화 가산을 받아 41,121,080원을 부정 청구하여 지급받음

C. On June 14, 2016, the Defendant rendered a disposition to recover KRW 56,537,650 from the Plaintiff pursuant to Article 43(1)3 of the Act on Long-Term Care Insurance for the Aged (hereinafter “instant disposition”).

[Ground of recognition] Facts without dispute, Gap evidence Nos. 1, 2, 5-12 (including virtual numbers; hereinafter the same shall apply) and the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The plaintiff's assertion (1) violates the criteria for placement of human resources.

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