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(영문) 서울행정법원 2018.10.04 2017구합77756
업무정지처분취소
Text

1. The plaintiff's claims against the defendants are all dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is an oriental medical doctor who operated the “Chanwon” in the Seoul Jung-gu Seoul Central District Court B and 3 (hereinafter “Korea Central Institute”).

B. Around July 2013, Defendant National Health Insurance Corporation (hereinafter “Defendant Corporation”) conducted on-site verification as to whether the claim for medical care benefit costs of Hanwon of this case was appropriate.

(hereinafter referred to as “on-site verification of this case”).

The Defendant Minister of Health and Welfare (hereinafter “Defendant Minister”) conducted on or around January 2016, on or after the Defendant’s request, an on-site investigation as to whether the medical care benefit cost of the instant Institute is appropriate (from July 2011 to February 2014).

(hereinafter “instant on-site investigation”). D.

For the following reasons, based on Article 98(1) of the National Health Insurance Act on June 19, 2017, Defendant Minister issued a disposition to suspend the operation of a medical care institution (hereinafter “instant disposition to suspend operation”) for 216 days (from June 26, 2017 to January 27, 2018) against the Plaintiff (hereinafter “instant disposition to suspend operation”).

double claim for medical care benefit after non-benefit medical treatment: Medical treatment records are recorded in the medical treatment records, and medical examination fees, etc. are claimed as medical care benefit costs, in accordance with Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance of 65,679,620 won, which provides a flexible extension operation for the cosmetic purpose subject to non-benefit pursuant to Article 9(1) [Attachment Table 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance.

E. Specific calculation of the period of business suspension of the instant case is as follows.

The total amount of costs of health care benefit for the investigation period (from July 201 to February 2014, 32 months) shall be 115,460,240 won 65,679,620 won 2,052,48 won 56.88% 216% of the total amount of costs of health care benefit for the investigation period (the average of the monthly unfair amounts) and the total amount of the unfair amounts.

F. On August 14, 2017, Defendant Corporation notified the Plaintiff of the decision to recover medical care benefit costs of KRW 65,679,620 based on Article 57 of the National Health Insurance Act.

(hereinafter referred to as “each disposition of this case” in the instant case.

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