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(영문) 서울고등법원 2013.09.27 2010누32602
과다본인부담금확인처분등취소
Text

1.The judgment of the first instance shall be modified as follows:

Schedule of Disposition by the Defendant against the Plaintiff.

Reasons

1. The facts below the confirmation of excessive principal charges and the disposition of refund are either in dispute between the parties or in each entry in Gap evidence Nos. 1 to 26 (including additional numbers), together with the purport of the entire pleadings.

[1] The plaintiff is a school foundation which establishes and operates a medical care institution under the National Health Insurance Act, which is a medical care institution under the Medical Care Assistance Act (hereinafter "Plaintiff hospital"), and the defendant is a corporation established under Article 55 of the National Health Insurance Act on June 29, 200 in order to examine medical care benefit costs and evaluate the appropriateness of medical care benefits.

Attached Form

In the disposal list, the students stated in the list of the patients (hereinafter referred to as the “persons of this case”) were blood patients, such as lebane disease or mathal disease (hereinafter referred to as “blood disease, such as lebal disease”), and were treated at the Plaintiff hospital between January 19, 200 and April 23, 2008, and paid their own charges to the Plaintiff hospital.

[2] Around 2008, the winners of the instant case requested the Defendant to verify whether the amount of the principal’s charge paid to the Plaintiff Hospital was excluded from the medical care benefits under the relevant statutes.

As a result of the examination, the Defendant: (a) in violation of the Rules on the Standards for Medical Care Benefits under National Health Insurance (amended by Ordinance of the Ministry of Health and Welfare No. 328 of Oct. 11, 2005; hereinafter “Rules on Medical Care Benefits Standards”); (b) details on the standards and methods for applying medical care benefits; (c) details on the standards for and methods of public announcement of the Health Care Benefits; and (d) the standards for benefits prescribed by the Administrator of the Korea Food and Drug Administration (hereinafter “the standards for benefits”); and (c) the payment of examination treatment medication or medical materials; and (d) the costs therefrom are equivalent to the amount stated in the separate sheet “the aggregate of the amounts to be borne by the Korean Food and Drug Administration” (hereinafter “each amount”).

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