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(영문) 부산고등법원 2015.03.19 2014누22120
요양급여비용 환수결정 처분취소
Text

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

Purport of claim and appeal

The first instance court.

Reasons

1. The issues of the instant case and the judgment of the court of first instance

A. On September 27, 2013, the key issue of the instant case was as a result of the on-site investigation conducted by the Ministry of Health and Welfare around September 27, 2013, that “as a result of verifying the Plaintiff’s claim for medical care benefit costs, the Defendant notified in advance that the Plaintiff would recover KRW 792,130,650 of the medical care benefit costs already paid pursuant to Article 57 of the National Health Insurance Act, etc. on December 2, 2013, as the Plaintiff did not report on the establishment and operation of meal service facilities under the Food Sanitation Act.” On December 18, 2013, the Defendant rendered a decision to recover the medical care benefit costs (hereinafter “instant disposition”).

According to Article 41 of the National Health Insurance Act, Article 21(2) of the Enforcement Decree of the National Health Insurance Act, and Article 5 [Attachment Table 1] of the Regulations on the Standards for Medical Care Benefits for National Health Insurance and Article 5 of the Enforcement Decree of the Regulations on the Standards for Medical Care Benefits for the Medical Care Benefits for the Medical Care Benefits of the Insured and their dependents, medical care institutions provide health care benefits such as medical examination, supply of medicine and materials, treatment operation, surgery, medical treatment, prevention, rehabilitation, hospitalization, nursing, transfer, etc. to the insured and their dependents. In particular, the meal for the hospitalized patient should be provided at

Article 8(2) and (4) of the Regulations on the Standards for Medical Care Benefits in National Health Insurance provides the patient's meals at a medical care institution equipped with the manpower and facilities standards prescribed by the Medical Service Act and the Food Sanitation Act, according to the guidelines for calculation of the patient's meals in Chapter 17 of the "the point of relative value of the expenses for the act of health insurance" publicly notified by the Minister of Health and Welfare

The term "" is defined as ".

The key issue of this case is ① meal service facilities prescribed by the Food Sanitation Act in the building illegally expanded and reconstructed by the Plaintiff.

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