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(영문) 서울행정법원 2018.05.31 2017구합84907
요양급여부지급처분취소
Text

1. Of the instant lawsuit, the medical care benefits restitution disposition that Defendant National Health Insurance Corporation rendered to the Plaintiff on April 10, 2017.

Reasons

1. Circumstances of each disposition of this case;

A. The Plaintiff is a legal entity that operates a C Senior Citizens Special Hospital (hereinafter “instant Senior Citizens Special Hospital”) and A Hospital (hereinafter “instant hospital”) in Hongsung-gun Special Metropolitan City (hereinafter “instant hospital”).

B. On December 2, 2016, the Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) notified the Commissioner of the Cheong-do Police Agency of the results of the investigation into the instant case on the abuse of medical care benefits related to D by the representative of the instant specialized hospital, and requested the Minister of Health and Welfare to conduct an on-site investigation into the medical care benefits of the instant specialized hospital and the medical care benefits of the instant hospital.

C. According to the results of the above on-site investigation, the Defendant Corporation rendered the Plaintiff a disposition to recover KRW 149,53,270 from January 10, 2017 based on Article 57(1) of the National Health Insurance Act (hereinafter “the instant disposition”) to recover KRW 149,53,270 for part of the Plaintiff’s unfair claim period on April 10, 2017 (hereinafter “the Plaintiff”) and to recover the Plaintiff’s unfair disposition (hereinafter “the Plaintiff”) with the exception of the amount of the cost of health care benefit determined to be recovered from the Plaintiff (hereinafter “the Plaintiff”) to the Plaintiff, as if the instant six nurses worked as a nurse at the Specialized Hospital for the Aged and the instant hospital.

On July 10, 2017, Defendant Corporation issued a new payment notice to KRW 131,260,040, which was not processed by electronic offset among the amounts recovered as the instant disposition No. 1. (hereinafter “instant payment notice”).

A. The instant notice of payment raises an objection to the disposition.

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