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1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
Reasons
1. Details of the disposition;
A. The Plaintiff is opening and operating a “C Women’s Council member” (hereinafter “instant Council member”) in the Gangnam-gu, Dong-gu, Dong-gu, Seoul.
B. Around November 2016, the Defendant conducted an on-site investigation on the matters concerning the medical care benefits and medical care of the instant member (hereinafter “instant on-site investigation”) by setting the period during which “from October 2013 to September 2016” was to be investigated.
C. On May 9, 2018, based on the results of the instant field investigation, the Defendant rendered a disposition to suspend the operation of a medical care institution for 81 days based on Article 98(1)1 of the National Health Insurance Act on the following grounds to the Plaintiff: (a) double claim for medical care benefit costs and medicine expenses (30,892,567 won) - the former Rules on the Standards for Medical Care Benefits in National Health Insurance (Amended by Ordinance of the Ministry of Health and Welfare No. 431, Aug. 4, 2016; hereinafter the same shall apply)
() Pursuant to Article 9(1) [Attachment 2](1) [Attachment 2] of the Act, the insurer (National Health Insurance Corporation) is required to pay medical care benefit costs by fraudulent or other unlawful means by providing medical care fees, etc., even though the medical care fees, etc. were collected from the winners as non-benefits (22,708,310 won). - As to the above medical care, the insurer is required to pay medical care benefit costs to the insurer by issuing an out-of-the-counter prescription as the subject of medical care benefits and allowing pharmacies to claim for pharmacy medication costs (8,184,257 won) by fraudulent or other improper means. D. The period of business suspension of the instant disposition is as shown below [Attachment 1]. [Attachment 1] The total amount of the medical care benefit cost for the period to be examined and decided [Attachment 1]. The total amount of the period of review and decision (276,074,920 won, 308, 2089, 5681.
E. On August 2, 2018, the Plaintiff requested the Central Administrative Appeals Commission to revoke the instant disposition by having the Defendant as the respondent, but on February 2, 2019.