[1] The legal nature of the "Standards for Recognition, etc. of Entrusted Inspection Agency" among the "Standards for Medical Insurance Fees" notified by the Ministry of Health and Welfare (negative 1)

[2] Whether a medical institution that was entrusted with the entrusted inspection by another medical care institution can directly claim the entrusted inspection expenses directly from the medical care institution (negative)

[1] Of the "Standards for Medical Insurance Fees" (amended by the Ministry of Health and Welfare No. 195-55 of Dec. 9, 1995), the "Standards for Recognition, etc. of Entrusted Inspection Institutions" is a provision that provides that the Minister of Health and Welfare shall prescribe specific matters such as the methods, procedures, scope, and upper standards of medical care benefits and delivery benefits, and the expenses thereof, as prescribed by the Medical Insurance Act delegated by the Minister of Health and Welfare, and shall be deemed as effective as an external binding legal order in combination with the function of supplementing the contents of the Act, unless it goes beyond the limit delegated by the Act. Thus, if the medical care institution's claim for medical expenses refuses to pay the medical expenses because it does not comply with the above provision, such disposition shall be deemed lawful unless there are any special circumstances.

[2] The purpose of "Standards for the recognition, etc. of entrusted inspection institution" in the "Standards for Medical Fees for Medical Insurance (amended by Ministry of Health and Welfare No. 1995-55 of Dec. 9, 1995) is to examine whether the inspection is necessary and appropriate for the medical treatment of the patient based on data, such as the statement of medical expenses, submitted by another medical care institution that requested the medical care institution to perform the inspection, and to determine that the institution is paid by the medical care institution that requested another medical care institution. Therefore, in light of such legislative intent, it is reasonable to interpret that a medical institution that conducted the entrusted inspection entrusted by another medical care institution cannot directly claim the expenses for the entrusted inspection directly from the medical care institution, and that the medical institution that conducted the entrusted inspection is designated as the medical care institution or that it was not recognized as the entrusted inspection institution.

[1] Articles 29(3) and 35(1) of the Medical Insurance Act / [2] Articles 29(3) and 35(1) of the Medical Insurance Act

[1] Constitutional Court en banc Order 95Hun-Ma390 decided Dec. 24, 1997 (Hun-Gong25, 140)

Plaintiff (Law Firm General Law Office, Attorneys Yoon Jong-sung et al., Counsel for the plaintiff-appellant)

Medical Insurance Federation (Law Firm White, Attorneys O upper-ryon et al., Counsel for the defendant-appellant)

Seoul High Court Decision 97Gu20566 delivered on October 16, 1998

The appeal is dismissed. The costs of appeal are assessed against the plaintiff.

Article 29(3) of the Medical Insurance Act provides that the standards for medical care benefits, such as methods, procedures, scope, and upper limits of medical care benefits, shall be determined by the Minister of Health and Welfare (Article 35(1) of the same Act provides that the expenses for medical care benefits or delivery benefits shall be calculated by the standards determined by the Minister of Health and Welfare after deliberation by the Deliberative Committee. Accordingly, the "Standards for the Recognition, etc. of Entrusted Examination Institutions" (Article 1995-5 of the Ministry of Health and Welfare announced on December 9, 1995) provided for in the form of public announcement by the Minister of Health and Welfare provides that the medical care institution fails to perform its functions as its own human resources, facilities, and equipment; thus, if the medical care institution requests another medical institution to perform a lawful examination, it shall be deemed that the institution entrusted with the examination provides that the medical care benefits shall be determined by the standards for medical care benefits, such as those for which the Minister of Health and Welfare requests the examination without any specific method and equipment associated with the examination and treatment, and that the institution so requests the examination institution so requested shall also provide the detailed criteria for the examination.

However, the purport of the foregoing provision is to ensure that the medical care institution requested another medical care institution to conduct an inspection and to receive the payment from the institution is to examine whether the inspection is necessary and appropriate for the patient’s medical treatment based on data, such as the statement of medical expenses, submitted by the medical care institution requested by the medical care institution. In light of such legislative intent, it is reasonable to interpret that the medical institution that conducted the entrusted inspection entrusted by another medical care institution cannot directly claim the expenses for the entrusted inspection. The fact that the medical institution that conducted the entrusted inspection was designated as the medical care institution or was not recognized as the entrusted inspection institution does not change.

In addition, interpreting the purport of the above provision as above, it cannot be deemed that it is unconstitutional because it is a provision that essentially infringes on the freedom of occupation of a medical institution that conducts an entrusted inspection or it is based on a provision that violates the principle of prohibition of comprehensive delegation

In the same purport, the court below is justified in holding that the plaintiff operating a radiation medical clinic (which was designated as a medical care institution, but not recognized as an entrusted inspection institution) was lawful in rejecting payment on the ground that the defendant, who requested the medical care institution to examine the 12 patient who was requested by another medical care institution to examine the radioactive (computer-type shooting) from March 1996 to April 196, the medical examination was conducted, and that the insurer's charge should be claimed in the medical care institution requesting the medical examination, and that there was no error in the misapprehension of the rules of evidence or the misapprehension of the legal principle as alleged in the grounds of appeal.

Therefore, the appeal is dismissed as it is without merit, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition.

Justices Shin Sung-sung (Presiding Justice)