1. The plaintiff's main claim is dismissed.

2. Medical care institutions that the Defendant rendered to the Plaintiff on September 6, 2018.

Details of the disposition

A. B as a doctor, established and operated a “D Council member” (agency No. E; hereinafter “previous Council member”) in Seo-gu, Seo-gu, Seocheon-gu, Incheon.

B. Around May 2016, the Defendant conducted a field investigation on the current status of the previous council members’ claim for medical care benefit costs.

(Period subject to Investigation: from April 2014 to May 5, 2015, 2016 to January 3, 2016; hereinafter “instant on-site investigation”). Unfair amount and details of calculation of administrative disposition

(a) Unfair amount: 44,937,380 won;

B. (1) Details of calculation of unfair amount 1) double claims for medical care benefit costs and unfair claims for medicine costs after non-benefit medical treatment: 43,723,374 won - Rule 9(1) [Attachment Table 2] of Article 9(1) of the Regulations on the Standards for Medical Care Benefits in National Health Insurance - Medical Care Benefits - Medical treatment for an injury or disease, such as “the injury or disease of the injury or disease,” even though the medical examination, etc. at the request of the person subject to non-benefit pursuant to Article 9(1) [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance,

(w) False claim for the number of days within 2 days: 1,214,300 - In the case of a certain person who has received a medical examination and treatment, it shall be recorded in the medical examination and treatment records, and medical examination fees, etc. shall be claimed as medical care benefit costs.

(c) Calculation details of administrative disposition (unit: origin, percentage, day). The total amount of medical care benefit costs for the period subject to investigation (from April 2014 to May 5, 2015, from January 1, 2016 to April 3, 2016, from January 3, 2016, 17). 622,495, 104, 44,937, 380 2,643, 375. 2169

C. Based on the results of the instant on-site investigation, the Defendant rendered a prior notice on February 1, 2017, on the grounds that B, when operating the previous member, he/she was liable for the medical care benefit cost of KRW 44,937,380 in total to the insurer, etc. by fraud or other improper means.

On July 26, 2017, the Plaintiff is a facility for B and the former Council member.