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(영문) 서울행정법원 2019.05.16 2017구합83140
업무정지처분취소
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 is establishing and operating the “Daehan” in Busan Shipping Daegu B and C (hereinafter “instant member”).

B. Around January 2014, the National Health Insurance Corporation (hereinafter “Corporation”) conducted on-site verification of the matters regarding the medical care benefit cost of the instant council members (hereinafter “on-site verification”), and requested the Defendant to conduct on-site inspection on the instant council members to the effect that “the Plaintiff charged the Plaintiff with the expenses to the students who were within the hospital for the purpose of receiving corrective corrective skills subject to non-payment, and subsequently, requested the Corporation to conduct a double claim for medical care benefit cost, and prescribed otherwise.”

C. On October 22, 2015, the Defendant conducted a field investigation (hereinafter “instant field investigation”) with respect to the instant member by setting the period during which the investigation was conducted (hereinafter “instant field investigation”) as “from September 22, 2012 to December 2013, and from June 2, 2015 to August 2015.”

Based on the results of the instant on-site investigation, the Defendant: (i) carried out a vision correction method to replace the safety and contact lenses subject to non-payment; and (ii) collected expenses from the winners as non-payment; (iii) unjustly claimed and received medical care benefit costs, such as medical examination fees; and (iv) unjustly charged the Corporation with KRW 39,064,958 of medical care benefit costs by issuing the relevant non-medical care benefit note; and (v) unfairly charged the Plaintiff with medical care benefit costs of KRW 39,064,958; and (v) on August 2, 2017, the Defendant issued the relevant non-medical prescription to the Plaintiff on August 2, 2017 (Amended by Act No. 13985, Feb. 3, 2016); and

E. (e) The calculation details of the period of suspension of the instant disposition are as shown below (attached Table 1). [Attachment 1] The total amount of costs of health care benefit (the average average of the unfair average amount for 19 months) during the period subject to investigation (the average of the unfair amount for 19 months) 83,034,130 won, 4,370,217 won 8.94%.

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