logobeta
본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
텍스트 조절
arrow
arrow
(영문) 창원지방법원 2020.11.12 2019구합54847
요양급여비용환수처분취소
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of disposition;

A. The Plaintiff is a medical corporation that operates a C convalescent hospital located in Chungcheongnam-gun, Chungcheongnam-gun (hereinafter “instant convalescent hospital”).

B. Around September 2019, the Defendant confirmed that the instant convalescent was paid by visiting the instant convalescent to determine whether the medical care benefit cost was properly claimed during the period from January 2016 to December 2, 2018, and confirmed that even if only the amount of co-payment is less than the annual amount of co-payment by the health insurance subscribers (hereinafter “recipients”) who received medical care benefits, such as treatment and hospitalization, in the instant convalescent hospital, the Defendant was paid the medical care benefit by claiming the Defendant for the amount exceeding

(hereinafter “Confirmation of the instant visit”). C.

On November 25, 2019, the Defendant rendered a disposition to recover medical care benefit costs of KRW 141,090,060 to the Plaintiff as follows:

(hereinafter “instant disposition”). Pursuant to Article 57 (Collection of Unjust Enrichment) of the National Health Insurance Act, the notice of the decision on the restitution of the medical care benefit cost is to recover the medical care benefit cost incurred for the following reasons, and to inform the amount of the next medical care benefit cost after deducting the relevant amount to be paid.

141,090,060 won computerized verification method for recovering reasons for the de facto decision on recovery of medical care benefit costs, and computer-based offsetting of restitution of unfair benefit costs (based on recognition), absence of dispute, Gap 1, Eul 6, and the overall purport of the pleading

2. The plaintiff's assertion

A. There is no legal basis to conduct an on-site investigation, such as visiting and verifying, in order to verify whether the defendant's procedural defect is adequate to claim medical care costs.

The National Health Insurance Act only grants the defendant the right to request the provision of data by the method of submitting a request for provision of data, and the defendant did not undergo the prior notification procedure.

In accordance with Article 11 of the Framework Act on Administrative Investigations, the defendant started an investigation on an advance basis without sending an on-site inspection report in advance.

The visit confirmation of this case is illegal and based on illegal on the field investigation.

arrow