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(영문) 서울행정법원 2019.11.14 2019구합57435
업무정지처분취소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Circumstances and details of the disposition;

A. The Plaintiff is a doctor operating “C Hospital” in Jinju-si B (hereinafter “instant hospital”).

B. On October 2015, the National Health Insurance Corporation (hereinafter “the instant on-site verification”) conducted on-site verification as to whether the instant hospital’s claim for medical care benefit costs is appropriate (hereinafter “the instant on-site verification”).

C. On November 2016, the Defendant conducted an on-site investigation as to whether the instant hospital claims the appropriateness of the medical care benefit cost.

(Period of Investigation: from January 2014 to December 2014, and from June 2016 to August 2016; hereinafter “instant on-site investigation”). D.

On December 21, 2018, the Defendant issued a disposition to suspend the operation of a medical care institution for 40 days (from March 25, 2019 to May 3, 2019) with respect to the instant hospital on the basis of Article 98(1)1 of the National Health Insurance Act with respect to the Plaintiff on the following grounds:

(2) In the event that a medical care benefit claim is provided under Article 41(1) of the National Health Insurance Act of KRW 75,376,079 (hereinafter “instant disposition”): Article 44 of the same Act and Article 19(1) of the Enforcement Decree of the same Act, if the medical care benefit is provided under Article 41(1) of the same Act, the medical care benefit claim shall be accurately calculated and collected; however, if the medical care benefit is provided under Article 41(1) of the Enforcement Decree of the same Act, the medical care benefit claim shall be accurately calculated and collected; however, the medical care benefit charge shall be collected in excess of the standard amount, such as the collection of pharmaceutical expense at least above the standard amount as follows: separate collection other than the standard amount of medical care expense 46,831,285 won: 2,343,389 won, separate collection other than the standard amount of medical care expense 2,26,201,405 won: 2,530,140 won;

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