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(영문) 서울북부지방법원 2017.09.21 2015고단4057
사기
Text

A defendant shall be punished by imprisonment for not less than one year and six months.

Reasons

Punishment of the crime

The defendant is the head of the "Dental Care Center", who is a sanatorium for older persons in the third and fifth floors of Gangseo-gu Seoul Metropolitan Government C building, and is the actual operator of the above medical care center.

The National Health Insurance Corporation, through the long-term care insurance for older persons, has a sanatorium for older persons who have difficulty in performing a mixed-child daily life for at least six months due to dementia cerebrovascular diseases, etc. among older persons aged 65 years or under 65 years of age provide them with facility benefits such as support for physical activities and education and training to maintain and improve their mental and physical functions, and provides them with care benefits for older persons.

The operator of a sanatorium for older persons may claim expenses for long-term care of older persons without reduction to the National Health Insurance Corporation, in accordance with the criteria for the placement of human resources of a sanatorium for older persons, such as one physician for medical care for older persons for older persons, one nurse for older persons for older persons for older persons for older persons, one qualified recipient for nursing for 2.5 persons for older persons, one qualified recipient for 25 persons for older persons, one physical nurse for older persons for each 30 beneficiaries (where the monthly working hours of one long-term care worker for older persons, or where the monthly working hours of at least 160 persons for same long-term care worker are combined, one long-term care worker for older persons shall be deemed assigned), and where the above criteria for the placement of older persons are not met,

On January 2014, the Defendant used the computer to access the information system on the National Health Insurance Corporation website, and did not work as a cook for medical care protection. The Defendant applied the reduction rate of 30% on the ground that F did not meet the standards for the placement of human resources of care facilities for older persons and applied the reduction rate of 160% on the ground that E applied the reduction rate of 30% on the grounds that F did not work as a physician for medical care protection, but filed a claim for long-term care benefits for older persons. However, the Defendant was working for 160 hours as E medical care protection physician, and filed a false report as if F worked for 74 hours as a doctor for medical care protection.

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