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(영문) 대전지방법원 2019.04.24 2018구합102941
업무정지처분취소
Text

1. The Defendant’s 40-day business suspension disposition against the Plaintiff on April 11, 2018 shall be revoked.

2...

Reasons

1. Details of the instant disposition

A. The Plaintiff is operating the C Hospital in Daegu-gu (hereinafter “instant hospital”).

B. On April 11, 2018, the Defendant rendered a 40-day disposition for the suspension of business of a medical care institution (hereinafter “instant disposition”) against the Plaintiff as follows:

Details of disposition: The legal ground for the suspension of business of a health care institution: The reason for the disposition under Article 98 (1) 1 of the National Health Insurance Act: The National Health Insurance Act (Articles 41, 44, 45, 46, 47, etc.), the Enforcement Decree of the same Act (Articles 19 and 21), the Enforcement Rule of the same Act (Articles 13, 16, and 19, etc.), the Rules on the Standards for Health Care Benefits in National Health Insurance, and other provisions concerning the calculation of health care benefit costs, in violation of the provisions concerning the calculation of health care benefit costs, the unfair amount of claims and the calculation

2. Details of unfair amount calculation;

(a) Unfair amount: 53,782,440 won;

(b) Details of detailed calculation of unfair amounts - 53,782,440 won - 53,782,440 won in violation of the calculation standards of unfair amounts - table of wages and expenses for health insurance activities and the points of relative value of benefits to inpatients in Chapter 2 of Part I of Part II of the point of relative value of meals in patients with at least hospital level under Article 1-51-B [m-51-B (2)] may be calculated only when two or more cooks belonging to the relevant health care institution work full-time. The class 1 of the treatment-type cooking may be calculated when the relevant health care institution work for at least five cooks, but it may be calculated where the number of cooks belonging to the relevant health care institution is calculated when the number of cooks belonging to the relevant health care institution is 8 or more full-time cooks, such as cook D, even if they work for a day-day period from January 1, 2014 to December 14, 2014.

3. Grounds related to the calculation details of administrative dispositions: Facts that there is no dispute over the criteria for the suspension of business and imposition of penalty surcharges under Article 70 (1) [Attachment Table 5] of the Enforcement Decree of the National Health Insurance Act, Gap evidence 1, Eul evidence 1, and purport of the whole pleadings.

2. This.

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