篇名

「醫療法人因多項重大違法過失遭取消保險醫療機關及保險醫師資格」事例   免費試閱

並列篇名

A Medical Foundation and Its Doctor in Charge Were Disqualified as a Contracted Health Insurance Institution and a Health Insurance Doctor Due to Multiple Illegal Practices

中文摘要

原告醫療法人A與其所開設診所K之院長B,起訴被告沖繩社會保險事務局C,主張其作成取消健康保險資格之處分應屬違法。經查原告本有浮報診療費用、未交付處方箋予病人、不實登載病歷等詐領健保情事,然原告認為取消資格處分前未踐行充分行政程序,無異強迫承認相關事實。惟判決認為被告實際上已對原告先後為行政指導、調查與聽證,且過程中原告亦未有合理說明。因此被告依健康保險法第80條判斷原告有顯著不正當情事,並為取消健保資格之處分,核無不法。原告敗訴。

英文摘要

The plaintiffs, the medical foundation A (which operated the clinic K) and doctor B (the director of clinic K), sued the defendant C (Okinawa Social Insurance Bureau) and claimed that the decision of their disqualification as contracted health insurance providers should be illegal. According to investigations, the plaintiff overstated the medical expenses, didn’t give patients their prescriptions, and made untruthful medical records to swindle money from health insurance. But the plaintiffs thought that the administrative procedures were not fully implemented before the penalty of disqualification, and that they were compelled to admit the truth. However, the court ruled that the defendant had given administrative guidance, carried out investigations and conducted hearings, but during these processes the plaintiffs still failed to give reasonable explanations for themselves. Therefore, it was legitimate for the defendant to determine the plaintiff has a significant misconduct and disqualified them as insurance providers according to health insurance law 80. The plaintiffs lost.

起訖頁

129-141

出版單位
DOI

10.3966/241553062017060008007  複製DOI  DOI查詢

QRCode

數位整合服務
產品服務
讀者服務專線:+886-2-23756688   傳真:+886-2-23318496   地址:臺北市館前路28號7樓

Copyright © 元照出版 All rights reserved. 版權所有,禁止轉貼節錄
TOP