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1. The plaintiff's primary claim and the conjunctive claim are all dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
Reasons
1. Details of the disposition;
A. The Plaintiff established and operated the “B Center,” which is a long-term care institution in Gangseo-gu Seoul Metropolitan Government (hereinafter “instant welfare center”), and provided beneficiaries with home care benefits.
B. The head of Gangseo-gu Seoul Metropolitan Government (hereinafter referred to as the “head of Gangseo-gu”) conducted a field investigation on the instant welfare center (the period subject to the investigation: the total of 17 months from August 1, 2015 to December 31, 2016; hereinafter referred to as “instant field investigation”) jointly with the Defendant for the investigation personnel from March 27, 2017 to March 30, 2017, and discovered the following violations.
1. Amount of unfair claims: 5,279,380 won;
2. Details of violations;
A. A claim for KRW 212,920 (i.e., KRW 960, Jan. 90, 2016; KRW 121,960, Feb. 121, 2016), even though the beneficiary C did not provide the beneficiary C with the actual visit care service on January 2, 2016 and February 2016;
B. B. During the period from March 19, 2016 to July 16, 2016, the beneficiary did not provide the beneficiary D with the actual visit care service. Even if the beneficiary did not provide the actual visit care service from July 19, 2016 to August 30, 2016 and from November 1, 2016 to December 29, 2016, the beneficiary claimed KRW 1,729,470.
(c) Claim 1,472,680 won, even though the beneficiary did not provide the beneficiary D with a visit medical service during the relevant month from September 1, 2016 to October 31, 2016.
(d) Claim KRW 1,864,310,00 even if the beneficiary did not provide beneficiary E with visiting medical care services from March 1, 2016 to June 17, 2016;
(e) Claim without reduction even though he/she subscribed to liability insurance on February 28, 2016 (one day).
C. On June 16, 2017, the Defendant rendered a decision to recover expenses for long-term care benefits of KRW 5,279,380 against the Plaintiff pursuant to Article 43 of the former Long-Term Care Insurance Act (amended by Act No. 15881, Dec. 11, 2018; hereinafter the same) (hereinafter “instant disposition”).
The Plaintiff is dissatisfied with the instant disposition and filed a petition for review with the Long-Term Care Adjudication Committee.