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(영문) 서울행정법원 2015.04.17 2013구합17725
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. As a dentist, the Plaintiff established a “A dental clinic” in Songpa-gu Seoul Metropolitan Government (hereinafter “instant clinic”) and performed medical treatment.

B. From May 21, 2012 to March 25, 2012, the employees of the Defendant’s field investigation team (hereinafter “Defendant’s field investigation team”) conducted a field investigation on the details of the instant member’s medical treatment for 34 months from June 2009 to March 2012 pursuant to the National Health Insurance Act (hereinafter “instant investigation”).

C. The Defendant on-site investigation team found the parts different from each other in the medical records and the receipt register prepared by the Plaintiff during the investigation process of the instant case. 1) Although it did not actually have to be provided, it claimed medical care benefit by stating it as having been provided within the medical records, 2) where the Plaintiff claimed expenses for medical care without having to be provided, and where the medical records were fully collected from the person who received the fees, and where the amount was collected from the person who received the fees, it stated that the medical records were provided with the medical records and the medical records were recorded as being provided with the medical records and the case where the person who received the fees was provided with double medical care benefits is classified as having been provided with the medical records and the case where the person who received the fees was claimed for double medical care benefits. 1) The Defendant on-site investigation team prepared a false list of the persons who received the medical records and the list of double applicants after the medical records

On May 27, 2013, the Defendant rendered a disposition to suspend the business of a medical care institution for 192 days (from July 29, 2013 to February 5, 2014; hereinafter “instant disposition”) against the Plaintiff pursuant to Article 98(1) of the National Health Insurance Act on the ground that the Plaintiff unduly claimed medical care benefit costs as above.

The total amount of costs of health care benefit for the investigation period (from June to March 34, 2012) is unfair.

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