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(영문) 서울행정법원 2020.11.12 2019구합85294
요양급여비용 환수처분 취소
Text

1. The Defendant’s disposition to recover the costs of health care benefit as of April 15, 2019 against the Plaintiff, and the costs of health care benefit as of June 17, 2019.

Reasons

1. Details of the disposition;

A. From March 5, 2008 to February 28, 2014, the Plaintiff is a doctor who was a title holder of the “Cvalescent Hospital” located in Yeonsu-gu Incheon Metropolitan City (hereinafter “instant hospital”).

B. The Commissioner of the Incheon Metropolitan City Local Police Agency notified the Defendant of the following investigation results:

From November 15, 2006, the suspect D and E without a doctor’s license obtained the permission to establish the so-called hospital in the name of Yeonsu-gu Public Health Center with the permission to establish the medical institution in the name of Yeonsu-gu Public Health Center. On March 2008, F, a doctor, was recruited to operate the so-called office hospital with the permission to establish the hospital in the Plaintiff’s name, on the condition that F, who was employed in the instant hospital at the time of the defect of resignation from office and worked as a principal doctor, would raise the Plaintiff’s salary from KRW 4 million to KRW 5 million.

According to such public invitation, the suspect D and E had the Plaintiff equipped with medical facilities, such as medical appliances, etc., and employed the Plaintiff, who is a doctor, as the hospital head, and had completed the instant hospital as if F had transferred F to the Plaintiff, entered into a false comprehensive transfer and takeover contract (F and transferee: the Plaintiff) with the false medical institution as if F had transferred F to the Plaintiff. The Plaintiff had obtained permission to establish the medical institution of the instant hospital in Yeonsu-gu Public Health Center by using his/her own medical license and the above contract, and operated the Plaintiff from around that time to February 24, 2014.

C. Based on the results of the above investigation, the Defendant: (a) based on Article 52(1) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201; hereinafter the same) and Article 57(1) of the National Health Insurance Act, on the ground that “The instant hospital was established by a person who is unable to establish a medical institution in violation of Article 33(2) of the Medical Service Act; and (b) provided medical care benefits under the National Health Insurance Act, even if it was unable to receive the medical care benefits, it was unjustly claimed and received.

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