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(영문) 서울서부지방법원 2013.11.22 2013가합32543
부당이득금
Text

1. The Defendant’s KRW 266,636,198 as well as 5% per annum from July 9, 2013 to November 22, 2013 as to the Plaintiff.

Reasons

1. Basic facts

A. The Plaintiff is a medical care institution as defined in Article 42(1)1 of the National Health Insurance Act, which is a school juristic person operating each other, in accordance with Article 42(1)1 of the Act on the Distribution of Seocho-gu Seoul Metropolitan Government, in Article 505 of the said Act, in Article 62 of the said Act and Article 42(1)1 of the said Act.

The defendant is an insurer of the health insurance established under Chapter 3 of the same Act, and the Health Insurance Review and Assessment Service (hereinafter referred to as the "Review and Assessment Service") is a corporation established under Article 62 of the same Act in order to examine the claim of medical care benefit

B. Under the National Health Insurance Act, the subject of the health insurance program consists of three different relationships between Defendant (the management of insurance benefits, the payment of expenses for insurance benefits, the imposition and collection of dues), health care institutions (the distinction between the medical institutions established under the Medical Service Act after the division of medicine and the pharmacies established under the Pharmaceutical Affairs Act) which are the insurer, and the insured.

(c) The process of paying insurance benefits is as follows:

(1) An account holder shall, after receiving medical care from a medical care institution, request the Review and Assessment Service to review medical care benefit costs.

(2) The Review and Assessment Service shall examine whether the requested details comply with the standards for the standards for the medical care benefits under national health insurance established pursuant to delegation under Article 41 (2) and (3) of the National Health Insurance Act, the detailed matters on the standards and methods for the application of medical care benefits publicly notified by the Minister of Health and Welfare (hereinafter collectively referred to as "standards for medical care benefits"), etc., and shall notify the medical care institutions

(3) The defendant shall pay medical care benefit costs to medical care institutions upon notification.

Until now, medical institutions conducted medical treatment, treatment, and preparation of medicines in the past.

Therefore, medical institutions;

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