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(영문) 서울행정법원 2017.05.25 2016구합80922
요양기관업무정지처분취소
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. The Plaintiff is a doctor to establish and operate Cental clinic B in Ansan-si, Ansan-si (hereinafter “instant clinic”).

B. On August 23, 2016, the Defendant rendered a disposition to order the Plaintiff to suspend the business of the instant member for 102 days from January 9, 2017 to April 20, 2017, under Article 98(1)1 of the National Health Insurance Act, based on the Plaintiff’s determination that the Plaintiff constitutes “a case where the insurer, policyholder, and dependent bears medical care benefit costs by fraud or other improper means.”

(hereinafter “instant disposition”). Specific grounds for the instant disposition are as follows.

1) After treating non-benefit medical care benefits, Article 9(1) [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in the National Health Insurance Act and Article 9(1) [Attachment 2] of the Enforcement Decree of the same Act and Article 19(1) of the Enforcement Decree of the same Act shall be calculated accurately and collected expenses to be borne by the person himself/herself pursuant to Article 44 of the same Act and Article 19(1) of the National Health Insurance Act in cases where the medical care benefits under Article 41(1) of the National Health Insurance Act are provided, even though it is collected from the person who received non-benefit in full as non-benefit in light of the list of the list of benefits and non-benefit benefits and the point of relative values of benefits for health insurance, it was collected in excess of 10,724,850 won by claiming for medical care fees, i.e., Japanese shock treatment fees, and combined renal treatment, and collecting excessive amount of 46,160,178 won.

3. A medical institution that intends to install and operate a radiation generator for diagnosis pursuant to Article 37 of the Medical Service Act and Articles 3 and 4 of the Regulations on the Safety Control of Radiation emitting Devices for Diagnosis after photographing unreported radiation equipment shall report to the head of a Si/Gun/Gu, as prescribed by Ordinance of the Ministry of Health and Welfare.

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