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1. The plaintiff's claim is 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 establishes and operates a building B in Busan, and a “DD Council member” in subparagraph C (hereinafter “instant Council member”).
B. On June 19, 2017, from around June 21, 2017 to June 21, 2017, the Defendant conducted an on-site investigation (hereinafter “instant on-site investigation”) with regard to all the matters pertaining to the medical care benefits of the instant council members by stipulating the period of investigation as “from August 19, 2015 to March 2017.”
C. On January 15, 2019, the Defendant rendered a disposition to suspend the operation of a medical care institution for 69 days based on Article 98(1)1 of the National Health Insurance Act (hereinafter “instant disposition”) on the ground that the Defendant unduly charged the Plaintiff with KRW 25,107,620 for medical care benefit costs as follows.
Article 9(1) [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance - Medical Care Benefits - Medical Care Institution shall directly purchase medicines necessary for medical care benefits in accordance with the criteria and methods for medical care benefits in attached Table 1 and pay to the person who has received the medical care benefits, and the medical care institution shall directly purchase medicines necessary for medical care benefits in accordance with Article 5(1) [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance - Medical Care Benefits - Medical Care Institution shall claim for the actual purchase of medicines used by the medical care institution within the scope of the maximum amount prescribed in the list of medicine benefits and the upper amount of benefits of the Ministry of Health and Welfare, but not directly purchase them and claim for the upper amount of the medical care expenses.
D. Details of the period of suspension of business of the instant disposition are as listed below [Attachment 1].
[Attachment 1] The total amount of medical care benefit costs (from August 2015 to March 2017, and 20 months) during the investigation period is unfair monthly average amount.