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(영문) 서울행정법원 2019.06.13 2015구합72467
요양급여비용환수처분 취소 청구의 소
Text

1. The Defendant’s redemption disposition of KRW 100,536,060 for long-term care benefit costs against the Plaintiff on August 5, 2015 is 65,246.

Reasons

Details of the disposition

From November 2009, the Plaintiff is operating a “C Visiting Care Center” (hereinafter referred to as “C”) designated as a long-term care facility for older persons from Seoul Gangnam-gu as a long-term care facility for older persons.

On June 2015, the Gangwon-gu Office and the defendant conducted a field investigation by setting the investigation period from April 2013 to March 2015 (total 24 months) as to whether C's claim for the cost of long-term care benefits is appropriate.

(2) On August 5, 2015, the Defendant notified the Plaintiff of the determination to recover expenses for long-term care benefits (hereinafter “instant amount to be recovered”) based on Article 43 of the former Act on Long-Term Care Insurance for the Aged (amended by Act No. 13647, Dec. 29, 2015; hereinafter the same) on August 5, 2015 as follows:

(hereinafter “instant disposition”). Specific grounds for the instant disposition are as follows.

A claim for failure to provide long-term care services per month: 18,753,560 won - If a claim for expenses for long-term care benefits is made pursuant to relevant statutes and public notice on expenses for long-term care benefits; however, if a beneficiary did not provide visiting care benefits, a claim for expenses for long-term care benefits is made by making a false statement on the “record on the provision of long-term care benefits” even if the beneficiary did not provide the beneficiary with visiting care benefits: 43,321,080 won - If a claim for expenses for long-term care benefits is made pursuant to relevant statutes and public notice on expenses for long-term care benefits, etc., but the beneficiary did not provide visiting care but did not provide the beneficiary with visiting care, and made a false statement on the record of the provision of benefits. A claim for expenses for long-term care benefits shall be made by increasing the number of days and the number of days of visiting care services but by making a false statement on the record of the provision of long-term care benefits.

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