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(영문) 대전고등법원 2014.09.26 2014노256
특정경제범죄가중처벌등에관한법률위반(사기)
Text

The prosecutor's appeal is dismissed.

An application for compensation by an applicant for compensation shall be dismissed.

Reasons

1. From the standpoint of the National Health Insurance Corporation that has the authority to investigate the actual transaction repayment system to eradicate rebates for the purpose of soundness in the finances of national health insurance, and from the perspective of the victim's National Health Insurance Corporation that has the authority to investigate the actual transaction of each drug transaction, the victim, as a matter of course, did not engage in transactions such as the payment of health care benefit, etc., if he/she knew of the fact that the I Hospital received a refund equivalent to 20% of the purchase price of the drug from M.

In addition, since the defendants did not notify it and filed a claim for the purchase price of 100%, not equivalent to 80%, as medical care benefits, and received it, the deception in fraud is recognized.

Nevertheless, the judgment of the court below which acquitted the Defendants on the facts charged of this case on the ground that the Defendants’ failure to notify the National Health Insurance Corporation of the receipt of rebates or the contestation does not constitute deception in fraud.

2. Determination on the grounds for appeal

A. In light of the following circumstances, the lower court acquitted the Defendants of the instant facts charged on the ground that the Defendants did not notify the National Health Insurance Corporation or the rice farm of the fact that the Defendants received money and valuables under the pretext of rebates from M does not constitute deception of fraud, and there is no evidence to prove otherwise that the Defendants obtained money from the National Health Insurance Corporation or the rice farm

(1) Even after the provisional repayment system has been modified by the amendment of the National Health Insurance Act and the Enforcement Decree thereof, the patient’s charges and medical care benefit costs are calculated on the basis of the maximum price publicly notified by the Minister of Health and Welfare by almost all medical personnel across the country, even after the provisional repayment system has been changed by the “actual repayment system.”

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