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(영문) 수원지방법원 2018.04.25 2017구합69398
요양급여비용환수고지처분취소
Text

1. On April 27, 2017, the Defendant’s materials costs reduction tape during the disposition to refund medical care benefit costs rendered to the Plaintiff.

Reasons

1. Details of the disposition;

A. As a doctor, the Plaintiff is operating the “Csan Women” (hereinafter “instant hospital”) in Ansan-si member B.

B. On March 10, 2017, the Defendant received information on the Plaintiff’s unfair supply of and demand for medical care benefit costs and requested investigation into the police. On March 10, 2017, the Gyeonggi-do Southern Provincial Police Agency notified the Defendant of the fact that the Plaintiff sent the Plaintiff as a prosecution opinion to the competent District Office within the Suwon District Prosecutors’ Office, and notified the Defendant of the fact that “The Plaintiff could not claim for medical care benefits costs (such as aid tape and Kater purchase cost), abortion surgery and maleological surgery without claiming insurance benefits, and medical care costs performed by an unqualified person.”

C. On April 27, 2017, based on Article 57 of the National Health Insurance Act, the Defendant notified the Plaintiff of the decision to recover the costs of health care benefit (hereinafter “instant disposition”) as follows.

(1) The contents of the decision are as follows: (i) recovery amount of non-benefit claim(s) - 9,766,380(s) - Non-benefit claim(s) 2,372,50(s) 24,822,00 of false material cost claim(s) - 24,822,00 of reuse of non-qualified persons(s) 77,626,980(s) 77,626,980 - false material cost claim(s) 1,200,583, 710 total sum of 1,315,171,

D. On June 28, 2017, the Plaintiff filed an objection with the Defendant on the ground that the part on the recovery decision of KRW 77,626,980 for medical care benefit costs related to the medical examination and treatment of unqualified persons (in the instant disposition of this case, the part on the recovery decision of KRW 1,200,583,710 for false claim of material costs (in the case of purchase cost of artificial tape) is not subject to recovery. However, the foregoing objection was dismissed on September 7, 2017.

[Ground of recognition] Unsatisfy, A No. 1.

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