Open Decision Ledger · Criminal law
Non-medical opening of a medical institution as one continuing crime by founder name
Supreme Court, Nov. 29, 2018, 2018Do10779 (judgment)
Case name: 보건범죄단속에관한특별조치법위반(부정의료업자)·사기·의료법위반·의료법위반방조
Official text on the National Law Information Center
Question
When a non-medical person leads the opening and running of a medical institution and the founder's name is changed to other medical persons during operation, is the series of acts one continuing crime that ends only on withdrawal from that leading role, and are the crimes under each founder's name separate offences in substantive concurrence?
Holding
The acts prohibited by Article 33(2) and punishable under Article 87(1)(ii) of the Medical Services Act are those by which a non-medical person, from a leading position, handles the staffing and management of facilities, the opening report, the practice of medicine, the raising of the necessary funds and the attribution of operating results. Such a series of acts is in principle one crime unless special circumstances exist, and the opening act ends not on completion of the opening report but only when the non-medical person leaves that leading role. Because the founder's name is an important mark for identifying the institution and its identity, a change of that name during operation breaks the unity of intent and the identity of the method, so separate crimes arise under each name and they stand in substantive concurrence.
Summary of the holding, verbatim
따라서 비의료인이 주도적인 입장에서 한 위와 같은 일련의 행위는 특별한 사정이 없는 한 포괄하여 일죄에 해당하고, 여기서의 개설행위가 개설신고를 마친 때에 종료된다고 볼 수는 없으며 비의료인이 위와 같은 주도적인 처리 관계에서 이탈하였을 때 비로소 종료된다고 보아야 한다.
Unofficial English translation
Accordingly, unless there are special circumstances, a series of acts such as those above performed by a non-medical person in a leading position constitute a single comprehensive offense, and the act of establishment here cannot be regarded as having ended upon completion of the report on establishment, and it must be regarded as having ended only when the non-medical person has withdrawn from the foregoing leading role in handling.
Disposition
Partly reversed and remanded Stated in the decision
원심판결 중 피고인 1, 피고인 2, 피고인 4에 대한 부분을 파기하고, 이 부분 사건을 서울동부지방법원 합의부에 환송한다. 피고인 3의 상고를 기각한다.
Unofficial English translation
The judgment of the court below is reversed insofar as it concerns Defendant 1, Defendant 2, and Defendant 4, and the case in this part is remanded to the collegiate panel of the Seoul Eastern District Court. The appeal of Defendant 3 is dismissed.
Form of the test
Elements stated Stated in the decision
동일 죄명에 해당하는 수 개의 행위를 단일하고 계속된 범의 아래 일정 기간 계속하여 행하고 그 피해법익도 동일한 경우에는 이들 각 행위를 통틀어 포괄일죄로 처단하여야 할 것이나, 범의의 단일성과 계속성이 인정되지 아니하거나 범행방법이 동일하지 않은 경우에는 각 범행은 실체적 경합범에 해당한다.
Unofficial English translation
Where several acts falling under the same charge are committed continuously over a certain period under a unitary and continuing intent and the protected legal interest is also the same, each of these acts must be dealt with as a single comprehensive offense in their entirety; however, where the unity and continuity of the intent cannot be recognized or the method of commission is not the same, each offense stands in substantive concurrence.
Factors
- 의료기관의 시설 및 인력의 충원·관리, 개설신고, 의료업의 시행, 필요한 자금의 조달, 운영성과의 귀속 등을 주도적인 입장에서 처리하는 것을 의미한다
- 특별한 사정이 없는 한 포괄하여 일죄에 해당하고
- 비의료인이 위와 같은 주도적인 처리 관계에서 이탈하였을 때 비로소 종료된다고 보아야 한다
- 그 범의가 단일하다거나 범행방법이 종전과 동일하다고 보기 어렵다
- 의료기관의 개설자 명의는 의료기관을 특정하고 동일성을 식별하는 데에 중요한 표지가 되는 것이므로
Unofficial English translation
• It means the handling, in a leading position, of the supplementation and management of the facilities and personnel of a medical institution, the filing of a report on establishment, the practice of medical services, the raising of necessary funds, the attribution of operating results, etc.
• Unless there are special circumstances, they constitute a single comprehensive offense, and
• It must be regarded as having ended only when the non-medical person has withdrawn from the foregoing leading role in handling
• It is difficult to regard the intent as unitary or the method of commission as identical to the previous one
• Because the name of the person who established a medical institution serves as an important marker for specifying the medical institution and identifying its identity, and therefore
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2011. 10. 27. 선고 2009도2629 판결(공2011하, 2478), 대법원 2014. 9. 25. 선고 2014도7217 판결(공2014하, 2148)
Unofficial English translation
Supreme Court Decision 2009Do2629 decided October 27, 2011 (Gong 2011 Ha, 2478), Supreme Court Decision 2014Do7217 decided September 25, 2014 (Gong 2014 Ha, 2148)
Decisions referred to
[1] 대법원 2011. 10. 27. 선고 2009도2629 판결(공2011하, 2478), 대법원 2014. 9. 25. 선고 2014도7217 판결(공2014하, 2148) / [2] 대법원 2010. 11. 11. 선고 2007도8645 판결(공2010하, 2285)
Burden of proof
Not addressed Not in the decision
Open question and revisit condition
What circumstances count as special circumstances that keep a change of founder's name within one continuing crime, and what conduct amounts to withdrawal from the leading role in handling the institution?
A later Supreme Court decision defining what counts as leaving the leading role in handling a medical institution would require this entry to be read again. Any amendment to Article 33(2) or Article 87(1)(ii) of the Medical Services Act also calls for a fresh reading.
Cross-family AI independent reading & axis check
7 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-26
A reader from another model family (GPT-6 Astra), given the official text but not the primary reading, agreed on 7 of the 8 axes; the readings differed on axis 8 (open question and revisit condition).
Axis 8 (Open question and revisit condition): Primary “What circumstances count as special circumstances that keep a change of founder's name within one continuing crime, and what conduct amounts to withdrawal from the leading role in handling the institution?” vs Independent “Would a substantial change in operational control without a change in the registered founder also divide the conduct into separate offenses?”
The primary reading asks what exception and withdrawal look like, while the independent reading asks about division without a name change, so they point to different leftover points.
따라서 비의료인이 주도적인 입장에서 한 위와 같은 일련의 행위는 특별한 사정이 없는 한 포괄하여 일죄에 해당하고, 여기서의 개설행위가 개설신고를 마친 때에 종료된다고 볼 수는 없으며 비의료인이 위와 같은 주도적인 처리 관계에서 이탈하였을 때 비로소 종료된다고 보아야 한다.Raw responses and comparison record: Protocol · Blind readings (JSONL) · Axis comparison (JSONL) · SHA-256 (JSON)
Lower-court contrast & scope of application
Lower-court reading vs. Supreme Court holding
Lower-court context: The Seoul Eastern District Court, in its judgment of 21 June 2018 (2018No143), held on its own motion that the 'opening' of a medical institution under Article 33(2) of the Medical Services Act does not include its 'operation'. It found that only the one medical person holding the founder's name changed while the facilities and medical staff kept their identity, and that Defendant 1 showed no intention to open a different medical institution, so the successive name changes did not amount to newly opening a medical institution. On that basis it acquitted Defendants 1 and 2 of the medical law charges and the charges of aiding, and acquitted Defendant 4.
Supreme Court standard: The Supreme Court held that this was a misapprehension of the law on the establishment and the number of offences of the medical law offence caused by a non-medical person's opening act, and that it affected the judgment. Each period under one founder's name is one crime taken together, and those crimes stand in substantive concurrence; Defendant 2 aided each of Defendant 1's crimes by introducing the medical persons in turn as employed doctors, and Defendant 4, who lent a dental licence name and worked as an employed doctor, is a joint principal. The acquittal parts of Defendants 1 and 2 had to be reversed along with the rest of their judgments because one sentence must be set for all parts in concurrence under Article 37, first sentence, of the Criminal Act, while Defendant 3's appeal was dismissed.
Distinguishing conditions
- Acts done after the non-medical person has left the leading role in handling the institution, since the opening act ends only at that point.
- A series of acts where special circumstances break the unity of intent or where the method of the offence differs, so that no single crime is taken together.
- An appeal by a defendant sentenced to less than ten years raising fact-finding, the weight of evidence or an unfair sentence, which Article 383(iv) of the Criminal Procedure Act does not accept as a ground.
Record verification notes
Set out each period of operation under one founder's name with its opening report and each date of name change, since the Court held that a separate offence arises under each name, in substantive concurrence. Then match every acquitted count with the parts already found guilty, because those parts share one sentence under Article 37, first sentence, of the Criminal Act and were reversed together. Confirm as well that the prosecution's appeal papers stated a ground of dissatisfaction, as they did not for the guilty parts.
From the official text
Points at issue
[1] 의료법이 제33조 제2항에서 비의료인의 의료기관 개설을 원칙적으로 금지하고, 제87조 제1항 제2호에서 이를 위반하는 경우 처벌하는 취지 / 위 조항에서 금지하는 ‘의료기관 개설행위’의 의미(=비의료인이 의료기관의 시설 및 인력의 충원·관리, 개설신고, 의료업의 시행, 필요한 자금의 조달, 운영성과의 귀속 등을 주도적인 입장에서 처리하는 것) / 비의료인이 주도적인 입장에서 한 일련의 의료기관 개설행위가 포괄일죄에 해당하는지 여부(원칙적 적극) 및 여기서의 개설행위가 종료되는 시기(=비의료인이 주도적인 처리 관계에서 이탈하였을 때) [2] 포괄일죄와 실체적 경합범의 구별 기준 / 비의료인이 의료기관을 개설하여 운영하는 도중 개설자 명의를 다른 의료인 등으로 변경한 경우, 그 죄수관계(=개설자 명의별로 별개의 범죄가 성립하고 각 죄는 실체적 경합범)
Unofficial English translation
[1] The purport of the Medical Service Act, which prohibits in principle the establishment of a medical institution by a non-medical person in Article 33 (2), and punishes a violation thereof in Article 87 (1) 2 / The meaning of the 'act of establishing a medical institution' prohibited by the foregoing provisions (= the handling, in a leading position, of the supplementation and management of the facilities and personnel of a medical institution, the filing of a report on establishment, the practice of medical services, the raising of necessary funds, the attribution of operating results, etc.) / Whether a series of acts of establishing a medical institution performed by a non-medical person in a leading position constitute a single comprehensive offense (in principle, affirmative) and the time at which the act of establishment here ends (= when the non-medical person has withdrawn from the foregoing leading role in handling) [2] The criteria for distinguishing a single comprehensive offense from substantive concurrence / Where, in the course of establishing and operating a medical institution, a non-medical person has changed the name of the person who established the institution to another medical professional or the like, the relationship as to the number of offenses thereof (= a separate crime is established for each name of the person who established the institution, and each crime stands in substantive concurrence)
Summary of the holding
[1] 의료법이 제33조 제2항에서 의료인이나 의료법인 기타 비영리법인 등이 아닌 자의 의료기관 개설을 원칙적으로 금지하고, 제87조 제1항 제2호에서 이를 위반하는 경우 처벌하는 규정을 둔 취지는 의료기관 개설자격을 의료전문성을 가진 의료인이나 공적인 성격을 가진 자로 엄격히 제한함으로써 건전한 의료질서를 확립하고, 영리 목적으로 의료기관을 개설하는 경우에 발생할지도 모르는 국민 건강상의 위험을 미리 방지하고자 하는 데에 있다. 위 의료법 조항이 금지하는 의료기관 개설행위는, 비의료인이 의료기관의 시설 및 인력의 충원·관리, 개설신고, 의료업의 시행, 필요한 자금의 조달, 운영성과의 귀속 등을 주도적인 입장에서 처리하는 것을 의미한다. 따라서 비의료인이 주도적인 입장에서 한 위와 같은 일련의 행위는 특별한 사정이 없는 한 포괄하여 일죄에 해당하고, 여기서의 개설행위가 개설신고를 마친 때에 종료된다고 볼 수는 없으며 비의료인이 위와 같은 주도적인 처리 관계에서 이탈하였을 때 비로소 종료된다고 보아야 한다. [2] 동일 죄명에 해당하는 수 개의 행위를 단일하고 계속된 범의 아래 일정 기간 계속하여 행하고 그 피해법익도 동일한 경우에는 이들 각 행위를 통틀어 포괄일죄로 처단하여야 할 것이나, 범의의 단일성과 계속성이 인정되지 아니하거나 범행방법이 동일하지 않은 경우에는 각 범행은 실체적 경합범에 해당한다. 의료법은 의료기관을 개설할 수 있는 자격을 엄격하게 제한하고 있고(제33조 제2항), 의료기관의 개설신고·개설허가에서부터 운영은 물론 폐업할 때까지 의료기관에 관한 각종 의무를 개설자에게 부과하고 있다(제33조 제3항 이하, 제36조 내지 제38조, 제40조, 제45조, 제48조, 제49조 등). 개설자가 변경되면 시장·군수 등에게 개설신고사항의 변경신고를 하거나 변경허가를 받아야 하고, 그때부터는 변경된 개설자가 앞에서 본 의무를 부담하게 된다. 그리고 의료기관이 국민건강보험법상 요양급여를 실시하려면 의료기관 개설신고증 등을 첨부하여 건강보험심사평가원에 요양기관 현황신고를 하여야 하고, 요양급여비용 수령계좌를 변경하려는 경우에는 개설자나 대표자의 인감증명서 등을 첨부하여 요양기관 현황 변경신고서를 제출하여야 한다(국민건강보험법 제42조, 제43조, 국민건강보험법 시행규칙 제12조 제2항). 요양기관이 보건복지부장관으로부터 업무정지처분을 받고 그 업무정지기간 중에 요양급여를 한 경우 개설자를 처벌한다(국민건강보험법 제115조 제3항 제4호). 이렇듯 의료기관의 개설자는 공법상 법률관계에서 중요한 의미를 지닌다. 또한 의료서비스를 제공받는 일반인도 대체로 의료기관을 선택할 때 의료기관의 개설자가 누구인지를 중요한 판단 기준으로 삼는다. 이러한 사정들을 고려하면, 의료기관의 개설자 명의는 의료기관을 특정하고 동일성을 식별하는 데에 중요한 표지가 되는 것이므로, 비의료인이 의료기관을 개설하여 운영하는 도중 개설자 명의를 다른 의료인 등으로 변경한 경우에는 그 범의가 단일하다거나 범행방법이 종전과 동일하다고 보기 어렵다. 따라서 개설자 명의별로 별개의 범죄가 성립하고 각 죄는 실체적 경합범의 관계에 있다고 보아야 한다.
Order
원심판결 중 피고인 1, 피고인 2, 피고인 4에 대한 부분을 파기하고, 이 부분 사건을 서울동부지방법원 합의부에 환송한다. 피고인 3의 상고를 기각한다.
Unofficial English translation
The judgment of the court below is reversed insofar as it concerns Defendant 1, Defendant 2, and Defendant 4, and the case in this part is remanded to the collegiate panel of the Seoul Eastern District Court. The appeal of Defendant 3 is dismissed.
Provisions referred to
[1] 의료법 제33조 제2항, 제87조 제1항 제2호, 형법 제37조 [2] 형법 제37조, 의료법 제33조, 제36조, 제37조, 제38조, 제40조, 제45조, 제48조, 제49조, 제87조 제1항 제2호, 국민건강보험법 제42조, 제43조, 제115조 제3항 제4호, 국민건강보험법 시행규칙 제12조 제1항, 제2항
Read 2026-10-26 · Cross-read 2026-10-26. All quotes matched against the official text. The Chinese-character placeholders the court used for anonymised parties are given in their Korean readings, and parenthetical Chinese-character glosses are omitted.
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