Plaintiff (Attorney Kim Jong-soo et al., Counsel for the plaintiff-appellant)

The Minister of Health and Welfare

January 17, 2006

1. The Defendant’s disposition of business suspension against the Plaintiff on September 30, 2005 is revoked.

2. The costs of the lawsuit are assessed against the defendant.

The same shall apply to the order.

1. Details of the disposition;

The following facts are not disputed between the parties, or can be acknowledged in full view of the whole purport of the pleadings as to Gap evidence Nos. 1, 2, and 4.

A. The Plaintiff, upon obtaining a medical license from the Defendant on February 20, 1988, established and operated “(title omitted)” as a medical institution that falls under the medical care institution under Article 9(1)1 of the Medical Care Assistance Act, in the Seo-gu, Chungcheongnam-gun (Seoul-gun omitted) from February 20, 1989.

B. After conducting an on-site investigation with respect to the above member between June 7, 2004 and October 11, 2006, the Defendant issued the instant disposition ordering the Plaintiff to suspend the business of an institution providing medical benefits for one year from October 2005 to October 19, 2006, by applying Article 28(1)2 of the Medical Care Assistance Act (hereinafter “Act”) and Article 33 and attached Table 3 of the Enforcement Rule of the Medical Care Assistance Act (hereinafter “Enforcement Rule”) to the Plaintiff on August 9, 2005, and Article 33(1)2 of the Enforcement Rule of the Medical Care Assistance Act (hereinafter “Enforcement Rule”).

2. The plaintiff's assertion and relevant Acts and subordinate statutes;

A. The plaintiff's assertion

The plaintiff asserts that the disposition of this case is unlawful for the following reasons.

(i)Violation of procedure

In rendering the disposition of this case, the defendant violated the Administrative Procedures Act that stated the reasons for the disposition of this case on the ground that the plaintiff did not state the specific reasons for the disposition of this case.

B. Doz.

Even if the facts are written differently from the facts in the Plaintiff’s medical records or the ledger for the receipt of personal charges, the Defendant applied Article 28(1)1 of the Act to the portion for which the Plaintiff unfairly claimed medical benefits based on the Plaintiff’s medical records or the ledger for the receipt of personal charges, barring sanctions by applying Article 28(1)1 of the Act, the Plaintiff did not manipulate the books or make a false report for the purpose of refusing, interfering with, or evading the Defendant’s on-site investigation. Therefore, the Defendant’

【Exercise of Discretionary Authority

In comparison with the details and degree of the Plaintiff’s medical records, etc., the method and period of sanctions or sanctions indicated in the instant disposition are excessively excessive, and in ordinary, the reason for such disposition is against equity compared with those imposed on the relevant medical institution by a penalty surcharge, and further, the instant disposition is an abuse of discretionary authority in view of the damage inflicted upon the patients due to the instant disposition and the Plaintiff’s contribution to the development of the community.

(b) Related statutes;

The entry of "related Acts and subordinate statutes" is as shown in the attached Table.

3. Whether the instant disposition is lawful

(a) Facts of recognition;

The following facts can be acknowledged in light of the aforementioned evidence, evidence No. 3, evidence No. 1 to No. 18-1 and No. 2, and the whole purport of the pleading.

(1) On April 23, 2004, the defendant, while running the (title omitted), provides a civil petition report that the plaintiff unfairly claims medical care costs to the insurer or the patient by stating medical records or the ledger of collection of personal care charges by falsity. On June 7, 2004, the defendant requested the plaintiff to submit to the plaintiff the records of medication by individual person, the statement of receipt of medical care costs, the ledger of receipt by individual recipient, the statement of receipt of medical care costs (medical care), the request for examination of medical care costs (medical care), the statement of medical care costs (medical care), the statement of medical care costs, and the documents concerning the purchase of medical care materials, and submitted the data possessed by the plaintiff.

B. From June 7, 2004 to June 12, 2004, the Defendant conducted an on-site investigation, such as conducting an interview or telephone liaison with some patients based on the data submitted by the Plaintiff, and discovered the following facts.

① Although the Plaintiff provided only 1-day medical treatment for the patient Nonparty 1, the Plaintiff entered the 12-day medical examination between March 9, 2004 and March 9, 2004 in the medical records, the Plaintiff provided 12-time medical treatment for the non-party 1. Although it did not provide other patient non-party 2 with medical treatment, the Plaintiff provided 6-time medical treatment between December 18, 2002 and May 1, 2003 and entered the same in the medical records as the patient non-party 3, non-party 4, non-party 5, non-party 2, non-party 6, non-party 7, non-party 8, non-party 9, and non-party 10, etc., and claimed the relevant medical expenses from the head of the competent Si/Gun, differently from the actual facts of medical treatment.

② The Plaintiff instructed the assistant nurse to use only 1/2 of the medication or 1/3 of the ample-ample-ample-lamp-lamp-lamp-lamp-lamp-lamp-lamp-lamp-lamp-lamp-lamp-lick-lamp

③ Article 11(1)1 of the Enforcement Rule provides that an institution providing medical benefits shall preserve a statement of expenses for medical benefits or a ledger of the receipt of personal charges to a medical care for five years from the date of the termination of medical care so that the Defendant, etc. can verify whether the institution providing medical care lawfully collects medical expenses from the patient. However, the Plaintiff, after treating a patient, entered the page “15+32:47” into the assistant nurse, and entered the page “15+32:47” into the assistant nurse, and entered the amount of KRW 4,700 from the patient as the assistant nurse received only 1,50 won from the patient, while the assistant nurse received KRW 4,700 from the patient according to the above description in the personal charge ledger, was unfairly received from the patient, and the amount entered in the original charge ledger was entered as part of the patient’s charge ledger

Article 22(1) of the Criminal Procedure Act provides that “The defendant shall, in the course of an on-site investigation, conduct an interview with some patients on the basis of the medical records submitted by the plaintiff or the telephone contact, and reveal the amount unfairly collected from the patients by confirming that the false facts are entered in the medical records or the personal charges collection register as above.” However, when the plaintiff was unable to discover the factual relations without entering the details thereof in the personal charges collection register as above, the defendant retired almost large parts and then the defendant was unable to discover the specific facts of violation, the defendant received a confirmation from the plaintiff or the assistant nurse to confirm the fact that the above detection was true through the existing data, and made a false report by the plaintiff on September 30, 2005.”

B. Determination

(1) First, we examine whether the Defendant’s application of Article 28(1)2 of the Act to the above detection is legitimate or not.

Article 28(1)2 of the Luxembourg Act provides that when an institution providing medical benefits violates an order to submit a report or document under Article 32(2) of the Act, or makes a false report, or refuses, interferes with, or evades an inspection or questioning by a public official under his/her jurisdiction, it may order the institution providing medical benefits to suspend its business for a period not exceeding one year. However, where an institution providing medical benefits violates Article 28(1)1 of the Act, Article 33 [Attachment Table 3](a) of the Enforcement Rule of the Act provides that the total amount of expenses for medical benefits during the period subject to investigation by the relevant institution providing medical benefits, unjust amount, and the period of suspension of business that may be imposed according to the type of the institution providing medical benefits is subdivided, and where special circumstances, such as business suspension under Article 29(1)2 of the Act cause severe inconvenience to beneficiaries, etc., the institution providing medical benefits may impose penalty surcharges within five times the amount of expenses for medical benefits unfairly imposed on beneficiaries, etc. under Article 29(1)2 of the Act.

Therefore, as can be seen from the above relevant laws, in comparison with the type and degree of sanctions in cases falling under Article 28 (1) 1 of the Act and Article 28 (1) 2 of the Act, as seen in the above relevant laws, the difference is significant. Article 28 (2) 2 of the Act provides that when an institution providing medical benefits interferes with an order to submit a false report or a false report by the public official belonging to the institution subject to submission, it shall be deemed to have the same degree of illegality as the one where the institution interferes with the inspection of the public official belonging to the institution, etc., and it is highly likely that the institution providing medical benefits would normally use false contents in the medical records or the ledger of personal charges when it imposes unfair medical expenses on the beneficiary or the head of a Gun, etc.

Article 28(1)2 of the Act provides that “The Plaintiff shall pay medical expenses to the beneficiary or the head of the Si/Gun unfairly by stating false or exaggerated details differently from the actual facts of the medical examination and treatment,” and the Defendant shall submit to the Defendant the medical examination and treatment or the ledger for the receipt of personal charges, which includes false details, as stated above, according to the Defendant’s order of submission. If there are such circumstances, the Plaintiff’s above act is merely that it had already been prepared before the Defendant’s prosecutor or the submission order was issued, and it cannot be deemed that such act constitutes a case where the Defendant’s report or the submission order was violated, or a false report was made. Therefore, the instant disposition is erroneous in the misapprehension of legal principles as to Article 28(1)2 of the Act, thereby applying the law of the

Applicant Accordingly, the disposition of this case cannot avoid revocation because it is unlawful on the ground that the disposition of this case erred in applying the relevant statute without examining the remainder of the plaintiff's remaining arguments.

4. Conclusion

Therefore, the plaintiff's claim of this case is reasonable, and it is decided as per Disposition by admitting it.

Judges Lee Tae-tae (Presiding Judge)