2019 High Court Order 1088 Violation of Medical Care Assistance Act, Violation of National Health Insurance Act

○○○ (63**********), doctor

Residence Southern-gu

Dayang-nam District in original domicile

Freeboard (prosecution), Kim-ju (Public Trial)

Attorney Kim Jong-hoon

April 28, 2021

Defendant shall be punished by a fine of three million won.

When the defendant fails to pay the above fine, the defendant shall be confined in the old house for the period calculated by converting 100,000 won into one day.

In order to order the provisional payment of an amount equivalent to the above fine.

Punishment of the crime

From November 3, 2016 to May 4, 2018, the Defendant is a person who operated the "Magju Hospital" in the Southern-gu of Gwangju.

The Minister of Health and Welfare may order medical care institutions (including medical care institutions) to report on medical benefits and insurance benefits or submit related documents.

The Defendant was investigated by the Health Insurance Review and Assessment Service and its employees from January 23, 2018 about whether the collection of medical care and medical care benefits was appropriate, while the Defendant was requested to submit medical care records in the name of the Minister of Health and Welfare on or around January 26, 2018.

Judgment on the argument of the defendant and defense counsel

1. Summary of the assertion

The instant on-site investigation was conducted without the participation of public officials belonging to the Ministry of Health and Welfare, and the defendant submitted all the medical records requested by the on-site investigation officers.

2. Acknowledgement of facts;

According to the evidence duly adopted and examined by this court, the following facts are recognized (the recognition of facts or circumstances is based on the evidence duly adopted and investigated by this court, and the purport of this is not stated separately).

A. In order to conduct the instant on-site investigation, the Minister of Health and Welfare organized an on-site investigation team comprised of staff members of the Ministry of Health and Welfare ○○○, ○○○, ○○○○, ○○○, ○○○, ○○○, ○○, ○○, ○○, and ○○○, and ○○, an employee of the National Health Insurance Corporation.

B. On January 23, 2018, Ma○○, etc. visited the instant hospital and signed the instant on-site investigation by presenting the investigation order under the name of the Minister of Health and Welfare, stating the period of investigation as from January 15, 2018, a request for submission of documents related to medical care (medical care) benefits under the name of the Minister of Health and Welfare, identification card, etc. The Defendant started the instant on-site investigation. The Defendant, upon receipt of a request for submission of documents related to medical care (medical care) benefits, entered the name and signed on January 23, 2018 at the right bottom of the request for submission of documents related to medical care (medical care).

A person shall be appointed.

A person shall be appointed.

C. On January 25, 2018, the investigator, including Ma○○, demanded the Defendant to submit medical records specified in the written request for submission of documents related to medical care (medical care) under the name of the Minister of Health and Welfare. However, the Defendant, on January 26, 2018, was sufficiently aware that a criminal charge or administrative disposition may be issued pursuant to relevant Acts and subordinate statutes at the time of refusal of an on-site investigation. However, the Defendant refused to submit materials while refusing to conduct the instant on-site investigation (the Ma○○○, a witness right-holder, submitted all the medical records requested by the investigator, such as Ma○, in this court, and stated to the effect that he did not refuse to submit such documents. However, in light of the witness’s legal statement and the relationship between Ma○○ and the Defendant, the above legal statement made by ○○○, a witness right-holder at the time

D. While the instant on-site investigation was conducted, Kim○, who is a public official belonging to the Ministry of Health and Welfare, and Lee ○○ did not visit the instant hospital.

3. Determination

A. Article 97(2) of the National Health Insurance Act provides that "The Minister of Health and Welfare may order a medical care institution to report on the insurance benefits, such as the provision of medical care and medicine, or to submit relevant documents, or require a public official under his/her control to question the relevant persons or inspect the relevant documents", and Article 32(2) and (5) of the Medical Care Assistance Act provides that "The Minister of Health and Welfare may order the institution providing medical care to submit a report or relevant documents on medical benefits, such as medical treatment and the provision of medicine, or may require public officials under his/her control to make inquiries or inspect the relevant documents" and "Except as otherwise provided for in this Act, the provisions of the Framework Act on Administrative Investigations shall apply to questions or the details, procedures, and methods of investigations under paragraphs

B. The Minister of Health and Welfare, on January 23, 2018, delivered a written request for submission of relevant documents to the Defendant through an investigator, including Ma○○, etc., and ordered the submission of medical records on January 25, 2018, but the Defendant refused to submit the relevant documents. In such a case, if an order is issued to submit relevant documents under the name of the Minister of Health and Welfare, even if the issuance of the said order through an employee belonging to the Review and Assessment Service for the following reasons, the refusal to submit the relevant documents constitutes “a violation of an order to submit documents under Article 97(2)” under Article 116 of the National Health Insurance Act and “a violation of an order to submit documents under Article 35(5) of the Medical Care Assistance Act” under Article 32(2).

1) In light of the contents and structure of the provisions of the National Health Insurance Act and the Medical Care Assistance Act as seen earlier, it is clearly distinguishable from the Minister of Health and Welfare’s order to submit reports or documents related to medical care (medical care) to the medical care institution under the name of the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in whose name the person in question

2) A public official belonging to the Ministry of Health and Welfare may inquire of interested parties or inspect related documents as delegated by the Minister of Health and Welfare (Article 97(2) of the National Health Insurance Act, Article 32(2) of the Medical Care Assistance Act), and a public official belonging to the Ministry of Health and Welfare, who conducts an on-site investigation, may request an institution for medical care (medical care) to submit relevant documents to the extent necessary for inspection without issuing an order to submit relevant documents. In such a case, the public official belonging to the Ministry of Health and Welfare may carry a certificate indicating his/her authority and produce additional documents to the interested parties (Article 97(6) of the National Health Insurance Act and Article 32(4) of the Medical Care Assistance Act), and a public official belonging to the Ministry of Health and Welfare is unlawful to entrust the authority of the Minister of Health and Welfare to the Review and Assessment Service or to request the submission of relevant documents by employees belonging to the Review and Assessment Service, who are not public officials belonging thereto (see, e.g., Supreme Court Decisions 2010Do211

However, this case is different from the case where a public official belonging to the Ministry of Health and Welfare requests submission of documents based on the authority of the Minister of Health and Welfare or submission of documents beyond the scope of the order of submission of relevant documents by the Minister of Health and Welfare without any order of submission of relevant documents, where the defendant fails to submit relevant documents.

3) The Defendant appears to have asserted to the effect that the refusal of investigation by the Defendant was justifiable since the instant on-site investigation was conducted only by the employees, etc. of the Review and Assessment Service. However, it is sufficient that the order of submission of relevant documents by the Minister of Health and Welfare is made under his/her own name and Welfare, and such order is not necessary to be delivered through public officials belonging to the Ministry of Health and Welfare. Therefore, even if the employees of the Review and Assessment Service who are not public officials belonging to the Ministry of Health and Welfare delivered the “written request for submission of medical care benefits (medical benefits)”, the order of submission of relevant documents by the Minister of Health and Welfare cannot be deemed unlawful.

C. Therefore, the defendant and defense counsel's above assertion is without merit.

Reasons for sentencing

○ Unfavorable Circumstances: The Defendant actively refused the instant on-site investigation by his own decision and refused to comply with an order to submit relevant documents under the name of the Minister of Health and Welfare, but denies all of the instant crimes.

The circumstances favorable to ○: the defendant does not have the same criminal records.

○ In addition, taking into account all the sentencing factors specified in the pleadings of the instant case, such as the Defendant’s age, character and conduct, family environment, motive, means and method of the crime, and circumstances after the crime, the number of fines for the summary order shall be maintained as they

Judges Kim Jong-tae