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(영문) 서울고등법원 2013.11.20 2013나2005471
부당이득금반환
Text

1. Of the judgment of the court of first instance, the part against the plaintiffs falling under the following order of payment shall be revoked.

Reasons

1. Basic facts

A. The Plaintiffs are those who establish and operate a health insurance medical care institution, and the Plaintiffs are designated as a free health examination institution.

B. The Plaintiffs conducted general medical examinations, life transition medical examinations, infant and child examinations, and cancer checkups for the patients. On the day of health examinations, the Plaintiffs provided medical treatment for other diseases on the same day, and was paid by Defendant National Health Insurance Corporation as medical care benefit costs for medical treatment of other diseases.

C. The Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) issued a medical examination notice to the Plaintiffs that the medical examination conducted an abnormal opinion on the number of persons on the day of the medical examination, or that the medical examination fees cannot be separately claimed as medical care benefit costs in addition to the health examination costs. However, the Defendant Corporation’s receipt of medical examination fees for the medical examination conducted by a medical examination doctor on the day of the medical examination, deeming that the medical examination did not constitute an insurance benefit cost by fraud or other improper means, and notified the Plaintiffs that the medical examination fees claimed as medical care benefit costs should be recovered in total amount of KRW 151,249,60,00,000 for the medical examination fees claimed as medical care benefit costs pursuant to Article 52(1) of the former National Health Insurance Act (amended by Act No. 9932, Jan. 18, 2010; hereinafter “National Health Insurance Act”). In sum, it collected KRW 148,067,790 after the

(hereinafter “instant restitution disposition”). The detailed details are as shown in the list of the status of dispositions and restitution by Plaintiff (Medical Care Institution) and the detailed list of restitution by Plaintiff.

On the other hand, Defendant Republic of Korea, based on the above restitution disposition against Plaintiff I and K, based on the National Health Insurance Act Article 85-2, is fraudulent and unfair.

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