[1] Method of interpreting the meaning of the language used in the law

[2] Whether a medical institution can interpret the term "insurance benefits" under Article 115 (2) 5 of the former National Health Insurance Act as a cover of the expenses that the National Health Insurance Corporation pays to a medical institution, etc. for the payment of insurance benefits, i.e., expenses for insurance benefits (negative)

[1] The meaning of the language and text used in the law, if any, must be determined by the relevant law. However, in addition to examining the ordinary meaning of the language and text, the systematic and logical understanding of how it is used in any meaning of the pertinent law should be made.

[2] According to Articles 1, 41(1), 47(1) and (3), 57(1), and 87(1) of the former National Health Insurance Act (amended by Act No. 14084, Mar. 22, 2016; hereinafter the same), with respect to “medical services provided in various forms, such as prevention, diagnosis, medical treatment, and rehabilitation for diseases, injuries, childbirth, etc. of patients, such as health insurance subscribers,” the National Health Insurance Act uses the term “insurance benefits” (hereinafter “medical benefits”) as “medical benefits,” and with respect to “expenses paid by the National Health Insurance Corporation in return for insurance benefits provided by a medical institution, etc.”, both are clearly distinguishable by using the term “insurance benefits expenses” (hereinafter “medical benefits expenses”).

Meanwhile, Article 119(1) of the former National Health Insurance Act (amended by Act No. 11787, May 22, 2013) provides, “If a person who was a policyholder, dependent, or a former policyholder or dependent becomes disqualified and has received insurance benefits by using a document certifying his/her eligibility, he/she shall be punished by a fine for negligence not exceeding an amount equivalent to the insurance benefits that he/she received,” and Article 119(2) of the same Act provides, “The National Health Insurance Act (amended by Act No. 11787, May 22, 2013) provides, “The National Health Insurance Act (amended by Act No. 11787, May 2, 2013) shall be punished by imprisonment with labor for not more than one year, or by a fine not exceeding one year, by newly establishing a new provision on punishment, instead of deleting Article 119(1) and (2) of the former National Health Insurance Act (amended by Act No. 11587, May 2, 20198).

As above, the former National Health Insurance Act clearly separates the “insurance benefits” and “insurance benefits cost” and comprehensively takes account of the fact that the penal provision is a newly established provision to strengthen punishment for the act of receiving insurance benefits by unlawful use of health insurance card, etc., the term “insurance benefits” under the penal provision refers to all kinds of medical services, such as providing medical services to patients, such as health insurance subscribers, injury, childbirth, etc., and cannot be interpreted as including expenses paid by the National Health Insurance Corporation for the payment of insurance benefits by medical institutions, etc.

[1] Article 12(1) of the Constitution, Article 1(1) of the Criminal Act / [2] Article 119(1) and (2) of the former National Health Insurance Act (Amended by Act No. 11787, May 22, 2013); Articles 1, 41(1), 47(1) and (3), 57(1), 87(1), and 115(2)5 (see current Article 115(3)5) of the former National Health Insurance Act (Amended by Act No. 14084, Mar. 22, 2016)

[1] Supreme Court Decision 2013Do841 Decided August 24, 2016 (Gong2016Ha, 141)

Defendant 1 and one other

Defendants

Attorney Park Sang-tae et al.

Seoul High Court Decision 2017No2786 decided January 30, 2018

The part of the lower judgment against the Defendants is reversed, and that part of the case is remanded to the Seoul High Court.

Before determining the grounds of appeal, we examine it ex officio.

1. The summary of Defendant 1’s violation of the National Health Insurance Act among the facts charged in the instant case against Defendant 1 is as follows: (a) Defendant 1, without a doctor, established and operated ○○○ Hospital (hereinafter “instant hospital”) which is a “office-general hospital” in collusion with co-defendants of the first instance trial; (b) claimed medical care benefits from the National Health Insurance Corporation and received insurance benefits by unlawful means as if the instant hospital was duly established under the Medical Service Act; and (c) Defendant 2 assisted and assisted Defendant 1 by facilitating the crime of violation of the National Health Insurance Act, such as Defendant 1, even though he was aware that the instant hospital was a hospital established and operated by non-medical persons.

The lower court found each of the above facts charged guilty by applying Article 115(2)5 of the former National Health Insurance Act (amended by Act No. 14084, Mar. 22, 2016; hereinafter the same) (a person who received or allowed another person to receive insurance benefits by fraud or other improper means; hereinafter referred to as “instant penal provision”).

2. However, it is difficult for the lower court to accept the punishment for each of the above facts charged for the following reasons.

A. The meaning of the language and text used in the law, if any, must be determined by the relevant law. However, in addition to examining the ordinary meaning of the language and text, the systematic and logical understanding of how it is used in the relevant law (see Supreme Court Decision 2013Do841, Aug. 24, 2016).

B. Article 1 of the former National Health Insurance Act provides, “The purpose of this Act is to contribute to the improvement of national health and the promotion of social security by providing citizens with insurance benefits for the prevention, diagnosis, and rehabilitation of diseases and injury, for childbirth and death, and for the improvement of health,” and Article 41(1) provides, “The provision of the following medical care benefits for the disease, injury, childbirth, etc. of the insured and their dependents shall be provided.” The provision provides, “(1) diagnosis and examination, 2. Medical care benefits, the provision of medicine and materials for treatment, 3. Medical treatment and rehabilitation, 4. Prevention and rehabilitation, 5. Nursing and rehabilitation, 6. Nursing and 7. Transfer.” In addition, Article 47(1) of the former National Health Insurance Act provides, “The Service may claim the payment of medical care benefits to the Service,” and Article 41(3) provides, “The Service, who is notified of the contents of the review under paragraph (2) of the same Article, shall, without delay, collect insurance benefits in accordance with the content of the insurance benefits.”

According to the above provisions of the former National Health Insurance Act, the National Health Insurance Act uses the term “insurance benefits” (the term “medical care benefits” provided by a medical care institution) with respect to “medical care benefits provided in various forms, such as prevention, diagnosis, medical treatment, and rehabilitation of patients, such as health insurance policyholders, etc.” and clearly distinguish between the two using the term “insurance benefits expenses” (the cost paid in return for the medical care benefits provided by a medical care institution, etc.) with respect to “the cost paid by the National Health Insurance Corporation in return for the insurance benefits provided by a medical care institution, etc.”

Meanwhile, Article 119(1) of the former National Health Insurance Act (amended by Act No. 11787, May 22, 2013) provides, “Where a person who was a policyholder, dependent, or a former policyholder or dependent has received insurance benefits using a document certifying his/her eligibility after becoming disqualified, he/she shall be punished by a fine for negligence not exceeding an amount equivalent to the insurance benefits he/she has received.” Article 119(2) of the same Act provides, “The National Health Insurance Act (amended by Act No. 11787, May 22, 2013) provides, “A person who has received insurance benefits through the transfer, lending, or other unlawful use of a health insurance card or identification card shall be punished by a fine not exceeding an amount equivalent to the insurance benefits.” However, the National Health Insurance Act (amended by Act No. 11787, May 22, 2013) newly established the instant penal provision in lieu of deletion of the foregoing penal provision, thereby imposing a fine not exceeding one year or less.”

C. As above, the former National Health Insurance Act clearly separates the “insurance benefits” and the “insurance benefits cost” and comprehensively takes account of the fact that the instant penal provision was newly established to strengthen punishment for the act of receiving insurance benefits by unlawful use of health insurance card, etc., the term “insurance benefits” under the instant penal provision refers to various medical services, such as treatment provided to patients, such as health insurance subscribers, injury, childbirth, etc., and cannot be interpreted as including expenses that the National Health Insurance Corporation pays for the insurance benefits by medical institutions, etc., i.e., expenses that the National Health Insurance Corporation pays.

Therefore, as in the facts charged, the act of establishing and operating the instant hospital in violation of the Medical Service Act and receiving insurance benefit costs from the National Health Insurance Corporation as if the instant hospital was a legally established hospital does not constitute the act of receiving “insurance benefits” subject to punishment under the instant penal provision, and thus, the instant penal provision cannot be applied to each of the facts charged.

Nevertheless, the lower court convicted each of the facts charged on the premise that the “insurance benefits” under the instant penal provision includes insurance benefit costs. In so doing, it erred by misapprehending the legal doctrine on the interpretation of “insurance benefits” under Article 115(2)5 of the former National Health Insurance Act, thereby adversely affecting the conclusion of the judgment.

3. Of the judgment below, there exist grounds for reversal as to Defendant 1’s violation of the National Health Insurance Act and the part concerning Defendant 2’s aiding and abetting the violation of the National Health Insurance Act as to Defendant 1. Since the court below sentenced Defendant 1 to a single punishment on the grounds that the above part and the remainder of the facts charged are concurrent crimes under Article 40 of the Criminal Act and the former part of Article 37 of the Criminal Act, Defendant 1 of the judgment below should be reversed in its entirety. In addition, since the court below sentenced Defendant 2 to a single punishment on the ancillary facts on the grounds that the above part concerning Defendant 2 and the remainder of the ancillary facts charged are concurrent crimes under Article 40 of the Criminal Act and the former part of Article 37 of the Criminal Act, the part concerning the ancillary facts should be reversed, and accordingly, the part concerning the main facts charged in the same body should be reversed in its entirety.

4. Therefore, without examining the grounds of appeal, the part of the judgment below against the Defendants is reversed, and the case is remanded to the court below for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Cho Jae-chul (Presiding Justice)