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(영문) 서울행정법원 2020.11.05 2019구합78951
업무정지처분 등 취소
Text

On June 4, 2019, the Minister of Health and Welfare issued a disposition of business suspension against the Plaintiff and December 24, 2019 against the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is an oriental medical doctor who has established and operates the Dawon in Yangcheon-gu Seoul Metropolitan Government and the 2nd floor (hereinafter “the instant oriental medical doctor”).

B. On January 2016, the Defendant Minister of Health and Welfare (hereinafter “Defendant Minister”) determined the period of investigation as “25 months from December 2012 to September 2014” and from September 2015 to November 2015, the Defendant conducted an on-site investigation of the instant Institute of Interest (hereinafter “instant on-site investigation”).

C. Based on the results of the instant on-site investigation, on June 4, 2019, on the ground that the Plaintiff rendered medical treatment, such as rain management, which is a matter excluded from medical care benefits pursuant to Article 9(1) [Attachment 2 of the Regulations on the Standards for Medical Care Benefits as follows (hereinafter “Rules on the Standards for Medical Care Benefits”), and filed a double claim for medical care benefit costs in breach of the standards for medical care fees calculation, and filed a claim for medical care benefit costs in violation of the standards for medical care fees calculation (amended by Act No. 13985, Feb. 3, 2016; hereinafter the same shall apply), Article 98(1)1 of the former National Health Insurance Act; Article 70(1) [Attachment 5] of the former Enforcement Decree of the National Health Insurance Act (amended by Presidential Decree No. 27433, Aug. 2, 2016; hereinafter the same shall apply) on the ground that the Plaintiff recovered the medical care benefit costs on the ground of business suspension 66 days (hereinafter “instant”).

AB made it.

1. Current status of medical care institutions and medical care institutions in this case;

2. Details of unfair amount calculation;

(a) Unfair amount: 29,285,650 won shall be expected to be collected by the National Health Insurance Corporation;

(b) medical care benefit costs double claims after the treatment subject to non-benefit of detailed calculation of the undue amount.

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