요양급여기준위반의 진료행위와 불법행위의 성립:

• 영문명: A Violation of Standards of Medical Care Benefits on Medical Treatment and Constitution of Illegal Act: In particular, Constitution of Outpatient Prescription as an Illegal Act
• 발행기관: 경희법학연구소
• 저자명: 박세창(Park, Sea-Chang)
• 간행물 정보: 『경희법학』제48권 제1호, 297~325쪽, 전체 29쪽
• 주제분류: 법학 > 민법
• 파일형태: PDF
• 발행일자: 2013.03.30

영문 초록

Since the separation of pharmacy and clinic. up to May 2007, had been inspected, if a medical off-prescription, that a doctor belonged a medical institution have issued to his patient, is wrote out to exceed the range of authorized criterion, by the Health Insurance Review Agency to prevent hospitals from using unnecessary medicine. And as a violation of the authorized criterion, exceeds the portion of the medical care expenses are restituted as a unfair profits. But the Supreme Court ruled that were invalid, as follow reasons; An obligator by unfair profits on article 52, Clause 1 of the National Health Insurance Law must be ‘a person or institution who get expenses by fraudulent means’. however, the medical institutions(a pharmacy, etc) not have any profits, but also by oneself use any fraudulent means. After the decision of the Supreme Court, the National Health Insurance Corporation deduct from the next medical care expenses to insist on his right of setoff against the indemnity bond based on the tort(as a violation of the authorized criterion). If so, is such a redemption as a indemnity bond on the law of tort(Article 750 of the Civil Law) of health insurance corporation justifiable? and if it could be, may can be uniformly set off by medical care expenses bonds of medical institutions? It has been the subject of discussion. In this dissertation, considered about legal nature of medical care expenses bonds and propriety of exercising a right of setoff as a redemption on article 750 of the Civil Law in order to protect medical care expenses claim of medical institutions.

목차

l. 서 설

ll. 요양급기준의 목적과 법적 성질

lll. 요양급기준위반의 위법성

lV. 손해와 손해의 발생

V. 결 어

키워드

건강보험 요양급여기준 건강보험공단 건강보험심사평가원 원외처방 약제비환수 임의비급여 health insurance standard of medical care benefits,National Health Insurance Corporation Health Insurance Review and AssessmentService outpatient prescription drug fee refund discretionary grant.