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(영문) 춘천지방법원강릉지원 2019.06.13 2018구합30373
의료급여 환수결정 취소청구
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 medical corporation that establishes and operates C Hospital B (hereinafter “instant hospital”).

At the instant hospital, the Plaintiff established and operated a self-official image photographing device, which is a special medical equipment as stipulated in Article 38(1) of the Medical Service Act (hereinafter referred to as “MRI”), and a Computerization-based photographing device (hereinafter referred to as “CT”), and reported Nonparty D (a medical specialist in the department of video and exclusive use) as a human resources to operate the said special medical equipment.

B. On January 2017, Nonparty 1 and the National Health Insurance Corporation conducted on-site surveys on the details of medical care costs of the instant hospital. As a result, Nonparty D did not perform the aforementioned duties for the above period on-site basis that “Nonindicted D was working at the instant hospital once or twice a month from June 20, 2012 to April 20, and filed a claim for medical care costs for simple radiation diagnostic fees after reporting it to work at the instant hospital as a full-time employee. Nonparty 1 had at least one exclusive personnel of the film department, CT had at least one non-exclusive personnel of the film department, and CT had at least one exclusive personnel of the film department, and C had a medical specialist of the film department performed the overall control and supervision of the quality control of the medical equipment of special medical care, film quality assessment, and clinical image reading, but Nonparty D did not perform the aforementioned duties in violation of Article 38 of the Medical Service Act, which was unfairly installed in violation of the Rules on the Operation of Non-Party 1 and 2.”

C. Accordingly, on May 3, 2018, the Defendant issued a disposition to recover KRW 31,280,430 from the Plaintiff’s medical benefits received by unjust means under Article 23 of the Medical Care Assistance Act (hereinafter “instant disposition”).

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