Claiming a more expensive drug than a generic

The MOHW, suspension of work

Pharmacist A filed a lawsuit to cancel the disposition of the other party of the MOHW

Court dismissed the claim.

Pharmacist A, who did not give a follow-up notice of general submission and charged for a drug that was more expensive than an alternative drug, filed a lawsuit claiming that it was an unfair disposition, but the court refused to accept it.

 

The Seoul Northern District Court recently dismissed a claim filed by pharmacist A against the NHIS for the return of unfair gains.

 

Pharmacist A did not notify the doctor after generic substitution of the drug from the MOHW in 2016, and was suspended for 50 days, claiming that the NHIS was unfairly paid about 34 million won.

 

Afterwards, the NHIS disposed of the collection of about 34 million won in unfair claims through notification of the results of the on-site investigation by the MOHW.

 

Since then, it has been executed in a way that deducts medical care benefits to be paid to pharmacies operated by pharmacist A.

 

After the disposition, pharmacist A filed a lawsuit with the Seoul Administrative Court, and in 2018, the pharmacist won the case.

 

For this reason, the court explained, "Some of the periods under investigation lack proof of the reasons for disposition, but the illegal parts of the disposition cannot be clearly distinguished, and some of the facts that were the basis for discretionary judgment are not recognized, forcing cancellation of all relevant dispositions." Immediately after that, the MOHW appealed to the Seoul High Court, but the pharmacist's victory was confirmed.

 

Based on the ruling, the pharmacist filed a lawsuit against the corporation to recover unfair profits.

 

Since the related disposition of the MOHW was canceled through administrative litigation, the disposition of the corporation, which recovered 34 million won in the name of unfair claims based on the same reason, is also illegal, so the recovered amount must be returned.

 

However, the court did not accept it.

 

It noted the reason why the court, which ruled in the previous ruling to cancel the administrative disposition of the MOHW, revealed it.

 

The court explained that just because the MOHW's disposition was canceled, there was no reason to cancel the separate disposition, the NHIS' redemption measure, saying it was unfair.

 

The court said, "The reason for canceling the disposition in an administrative lawsuit against the cancellation of the disposition of the MOHW is that there is a lack of proof of facts regarding 'part' of the reasons for the disposition." As a lack of proof of some of the reasons for disposition, it falls under the case where the presence or absence of the defect is revealed only when the facts are accurately investigated.

 

It is difficult to say that the defect in the disposition of this case has reached a significant and obvious degree, it said.

 

He then said, "It is a separate and independent disposition based on a separate provision of the (former) National Health Insurance Act, even though the facts and the previous disposition of the MOHW are common." The court said, "Even if the related disposition is canceled, the NHIS cannot be ordered to return the disposition because the degree of defect in separate disposition has not naturally reached invalidity.

 

The pharmacist's claim is dismissed for no reason, it said.