[1] Method of interpreting the meaning of the language used in the law

[2] The meaning of “insurance benefits” under Article 115(2)5 of the former National Health Insurance Act (i.e., providing various medical services, such as treatment provided to patients, such as health insurance policyholders, etc. with respect to disease, injury, childbirth, etc.), and whether medical institutions, etc. can interpret the same as including expenses paid by the National Health Insurance Corporation for the insurance benefits (negative)

[1] Article 12(1) of the Constitution, Article 1(1) of the Criminal Act / [2] Article 12(1) of the Constitution, Article 1(1) of the Criminal Act, Article 119(1)(current deleted) and (2)(current Deletion) of the former National Health Insurance Act (Amended by Act No. 11787, May 22, 2013); Articles 1, 41(1), 47(1) and (3), 57(1), and 115(2)5(see current Article 115(3)5) of the former National Health Insurance Act (Amended by Act No. 14084, Mar. 22, 2016)

[1] [2] Supreme Court Decision 2018Do2615 Decided June 15, 2018 (Gong2018Ha, 1343) / [1] Supreme Court Decision 2013Do841 Decided August 24, 2016 (Gong2016Ha, 141)

Defendant 1 and one other

Prosecutor

Law Firm Squa, Attorneys Kim Tae-tae et al.

Daejeon High Court (Cheongju) Decision 2017No108 decided December 14, 2017

All appeals are dismissed.

The grounds of appeal are examined.

1. As to the ground of appeal on Defendant 1’s violation of the Pharmaceutical Affairs Act and the violation of the Act on the Aggravated Punishment, etc. of Specific Economic Crimes (Fraud)

On the grounds indicated in its reasoning, the lower court reversed the first instance judgment convicting the Defendant on the charge of violating the Pharmaceutical Affairs Act and the violation (excluding the part on the charge) of the Act on the Aggravated Punishment, etc. of Specific Economic Crimes (Fraud) among the facts charged in the instant case, and found the Defendant not guilty on the grounds thereof. The record reveals that the lower court did not err by misapprehending the bounds of the principle of free evaluation of evidence in violation of logical and empirical rules

2. As to the Defendants’ ground of appeal on the violation of the National Health Insurance Act

A. The meaning of the language and text used in the relevant law, if any, must be determined by the relevant law. However, in addition to examining the ordinary meaning of the language and text, the systematic and logical understanding of how it is used in the relevant law (see Supreme Court Decision 2013Do841, Aug. 24, 2016, etc.).

B. (1) Article 1 of the former National Health Insurance Act (amended by Act No. 14084, Mar. 22, 2016; hereinafter the same) provides, “The purpose of this Act is to contribute to the improvement of national health and the promotion of social security by providing citizens with insurance benefits for the prevention, diagnosis, medical treatment, rehabilitation, childbirth, death, and improvement of health.” Article 41(1) provides, “The provision of the following medical care benefits for the illness, injury, childbirth, etc. of the insured and their dependents shall be provided.” Article 41(1) provides, “The Corporation shall provide the following medical care benefits for the disease, injury, or childbirth, etc. of the insured and their dependents.” Article 1 provides, “1. Medical examination and inspection, 2. Medical treatment and treatment, 3. Medical treatment and operation, prevention and rehabilitation, 4.5. Nursing, and 7. Medical care institutions may claim for the payment of medical care benefits to the Corporation,” and Article 47(1) of the former National Health Insurance Act provides, “The Corporation or its payment without delay.”

(2) According to the above provisions of the former National Health Insurance Act, the National Health Insurance Act uses the term “insurance benefits” (hereinafter “medical care benefits”) with respect to “medical care benefits provided in various forms, such as prevention, diagnosis, medical treatment, and rehabilitation against illness, injury, childbirth, etc. of patients, such as health insurance policyholders,” and clearly distinguish between the two by using the term “insurance benefits expenses” (hereinafter “medical care expenses”) with respect to “expenses paid in return for the insurance benefits provided by the National Health Insurance Corporation to a medical institution, etc.” (hereinafter “medical care expenses”).

(3) Meanwhile, Article 119(1) of the former National Health Insurance Act (amended by Act No. 11787, May 22, 2013) provides that “where a person who was an insured person, dependent, or a former insured person or dependent has received an insurance benefit by using a document certifying his/her eligibility after becoming disqualified, an administrative fine not exceeding the amount equivalent to the insurance benefits that he/she received shall be imposed.” Article 119(2) of the same Act provides that “The National Health Insurance Act amended by Act No. 11787, May 22, 2013 (hereinafter referred to as the “National Health Insurance Act”) provides that “a person who received an insurance benefit through the transfer, lending, or other unlawful use of the health insurance card or identification card shall be punished by an administrative fine not exceeding an amount equivalent to the insurance benefits.” However, the National Health Insurance Act, which was amended by Act No. 11787, May 22, 2013, newly inserted Article 119(1)5(2)5 and (5)5)5)5, thereby allowing another person to receive or a fine not exceeding one year.”

C. As above, the former National Health Insurance Act clearly separates the “insurance benefits” and the “insurance benefits cost” and comprehensively takes account of the fact that the instant penal provision was newly established to strengthen punishment for the act of receiving insurance benefits by unlawful use of health insurance card, etc., the term “insurance benefits” under the instant penal provision refers to various medical services, such as treatment provided to patients, such as health insurance subscribers, injury, childbirth, etc., and cannot be interpreted as including expenses that the National Health Insurance Corporation pays for the insurance benefits by medical institutions, etc., i.e., the “insurance benefits cost.”

D. The lower court was justifiable to have determined the same purport as to Article 115(2)5 of the former National Health Insurance Act and rendered a not guilty verdict on this part of the facts charged against the Defendants. In so doing, contrary to what is alleged in the grounds of appeal, the lower court did not err by misapprehending the legal doctrine on the interpretation of the “insurance benefits” under Article 115(2)5 of

3. Conclusion

Therefore, all appeals are dismissed. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Park Sang-ok (Presiding Justice)