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(영문) 서울행정법원 2018.08.16 2017구합73501
요양급여비용 환수처분 취소 청구의 소
Text

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. From December 3, 2013, the Plaintiff was designated and operated as a long-term care institution (hereinafter “instant medical care institution”) and operated by the Cmedical Care Center established in the Namyang-si B (hereinafter “instant medical care institution”).

B. On December 19, 2016, the Namyang-ju Mayor and the Defendant conducted a field investigation on the instant medical care institution from December 19, 2016 to December 22, 2016.

(Period subject to Investigation: From April 2014 to October 2016; hereinafter “instant on-site investigation”). From January 2, 2015 to April 2015, D registered as a nurse during the period from January 2, 2015 to April 31, 2015, reported the cost of benefits as if he/she actually worked as an assistant nurse, and filed a false claim for the cost of benefits, even if he/she did not actually work as an assistant nurse.

Even if there is an additional placement of human resources in the relevant month to which the calculation of reduction is applied due to a violation of the criteria for placement of human resources in violation of the criteria for placement of additional placement of human resources of KRW 37,803,00,000, the additional placement of human resources was added due to the placement of a cook during the period during which the reduction is applied due to a vacancy, as above.

926,920 Won 38,729,920

C. On April 14, 2017 based on the results of the instant on-site investigation, the Defendant issued a disposition to recover total of KRW 38,729,920 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 “Act”) on the grounds that the Plaintiff unduly claimed and received expenses for long-term care benefits by violating the criteria for placement of human resources and additional placement guidelines as follows (hereinafter “instant disposition”).

(hereinafter “Disposition in this case”). 【No dispute exists, entry of Gap’s evidence Nos. 1 through 5, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. 1 Plaintiff’s assertion as to the existence of the grounds for disposition D is mainly an assistant nurse’s service who is not a caregiver from January 2015 to March 2015.

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