Open Decision Ledger · Civil obligations & remedies
Meaning of the same-paragraph levy and whether it may exceed the nominal founder's
Supreme Court, Mar. 12, 2026, 2024Du52519 (judgment)
Case name: 요양급여비용환수결정취소[구 국민건강보험법 제57조 제2항에서 정한 징수금의 의미 및 범위가 문제 된 사건]
Official text on the National Law Information Center
Question
What does ‘the levy under the same paragraph’ in Article 57(2) of the former National Health Insurance Act mean, and may the unjust-enrichment levy collectible from the substantial founder jointly with the nominal founder be set higher than the levy imposed on the nominal founder's medical institution under Article 57(1)?
Holding
The ‘same paragraph levy’ is not a sum the substantial founder bears in a subordinate position within the levy imposed on the hospital. It is the whole or part of the insurance benefit costs the substantial founder obtained through the hospital, after a discretionary assessment of the weight of each party's responsibility. The two are independent obligors in a joint and several relationship, so the levy on the substantial founder may, because of that discretionary assessment, be set higher than the levy imposed on the nominal founder's institution under Article 57(1).
Summary of the holding, verbatim
그러므로 구 국민건강보험법 제57조 제2항에서 정한 ‘같은 항에 따른 징수금’이란, ‘실질적 개설자가 요양기관에 대한 종속적 지위에서, 요양기관에 부과된 부당이득징수금 범위 내에서 부담하는 징수금’이 아니라, ‘실질적 개설자가 요양기관을 통해 속임수나 그 밖의 부당한 방법으로 받은 보험급여비용 중 책임의 경중에 대한 재량적 판단을 거쳐 정해진 그 전부 또는 일부’를 의미한다.
Unofficial English translation
Therefore, the "collection amount as provided in the same paragraph" under Article 57 (2) of the former National Health Insurance Act does not mean "a collection amount borne by the de facto establisher in a subordinate position to the medical care institution, within the scope of the unjust enrichment collection amount imposed on the medical care institution," but means "the whole or part of the insurance benefit expenses received by the de facto establisher through the medical care institution by deception or other unjust methods, as determined through discretionary judgment as to the degree of responsibility."
Disposition
Dismissed Stated in the decision
상고를 모두 기각한다. 상고비용은 원고들이 부담한다.
Unofficial English translation
All appeals are dismissed. The costs of the final appeal shall be borne by the plaintiffs.
Form of the test
Elements stated Stated in the decision
실질적 개설자는 부당이득징수처분에 따라 개설명의자와 독립하여 부당이득반환의무를 부담하되 개설명의자인 요양기관과 연대책임을 지는 관계에 있다.
Unofficial English translation
The de facto establisher bears the obligation to return unjust enrichment independently of the nominal establisher pursuant to the disposition for collection of unjust enrichment, but stands in a relationship of joint and several liability with the medical care institution that is the nominal establisher.
Factors
- 요양기관이 실시한 요양급여 내용과 요양급여비용 액수
- 의료기관 개설·운영 과정에서 개설명의자와 실질적 개설자의 각 역할과 불법성의 정도
- 의료기관 운영 성과의 귀속 여부와 개설명의자가 얻은 이익의 정도
Unofficial English translation
• The content of the medical care benefits provided by the medical care institution and the amount of the medical care benefit expenses
• The respective roles of the nominal establisher and the de facto establisher in the course of establishing and operating the medical institution, and the degree of illegality
• Whether the results of the operation of the medical institution are attributable and the degree of the benefits obtained by the nominal establisher
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2018. 11. 29. 선고 2018도10779 판결(공2019상, 248)
Unofficial English translation
Supreme Court Decision 2018Do10779 decided November 29, 2018 (Gong 2019 Sang, 248)
Decisions referred to
대법원 2018. 11. 29. 선고 2018도10779 판결(공2019상, 248), 대법원 2020. 6. 4. 선고 2015두39996 판결(공2020하, 1367), 대법원 2020. 7. 9. 선고 2018두44838 판결(공2020하, 1609), 대법원 2020. 9. 3. 선고 2015다230730 판결
Burden of proof
Not addressed Not in the decision
Open question and revisit condition
When the levy on the substantial founder exceeds the levy on the nominal founder's institution, what limits does Article 21 of the Framework Act on Administration place on the discretionary division of responsibility between them?
A later decision setting limits on how the Health Insurance Service may exercise that discretion, or a further amendment to Article 57 of the National Health Insurance Act, would require this entry to be read again.
Cross-family AI independent reading & axis check
8 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-24
A reader from another model family (GPT-6 Astra), given the official text but not the primary reading, agreed on all 8 axes.
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 Gwangju High Court, in its judgment of 25 July 2024 (2023Nu12766), found no defect in the reduced levies against Plaintiffs 2 and 3 and rejected the claims on that part. It held that the Health Insurance Service's reductions, made after preparing its internal guideline on handling the disposition of illegally opened institutions, did not abuse discretion, were not contrary to the binding force of the earlier cancellation judgment, and did not breach the principle of proportionality.
Supreme Court standard: The Supreme Court found no error. It held that the court below had not misread the law on Article 57(2)(i) of the former National Health Insurance Act, had not misapplied the standard for discretionary action under Article 21 of the Framework Act on Administration, and had not failed to examine what was needed on the binding force of the cancellation judgment, the curing of defects and the discretionary guideline. It dismissed all the appeals, with the Justices unanimous.
Distinguishing conditions
- A case in which the substantial founder stood in a subordinate position to the hospital, so that the levy borne falls within the amount imposed on the hospital.
- A case in which the person did not lead the recruitment and management of facilities and staff, the opening report, the practice of medicine, the raising of funds and the attribution of operating results, so that the conduct is not the act of a non-medical person opening a medical institution prohibited by Article 33(2) of the former Medical Service Act.
- A case in which the person was employed by the substantial founder, received only consideration for the work supplied, and no operating profit of the institution accrued to them, the position the Court described for the nominal founder.
Record verification notes
Set out the roles of the nominal founder and each alleged substantial founder in the facilities and staffing, the opening report, the financing and the attribution of operating results, and note what each received, since the Court relies on the differing weight of responsibility. Then compare the total insurance benefit costs received through the hospital with the sum of the levy imposed on the institution and the levy imposed on each person, and check which version of Article 57 governs the disposition at issue.
From the official text
Points at issue
구 국민건강보험법 제57조 제2항에서 정한 ‘같은 항에 따른 징수금’의 의미 및 위 조항 제1호에 따라 실질적 개설자에게 개설명의자와 연대하여 납부하게 할 수 있는 부당이득징수금을 같은 조 제1항에 따라 개설명의자인 요양기관에 부과되는 부당이득징수금을 초과하는 금액으로 정할 수 있는지 여부(적극)
Unofficial English translation
Whether the term "collection amount as provided in the same paragraph" as used in Article 57 (2) of the former National Health Insurance Act means, and whether the unjust enrichment collection amount that may, pursuant to subparagraph 1 of the same Article, be imposed on the de facto establisher to be paid jointly and severally with the nominal establisher may be set at an amount exceeding the unjust enrichment collection amount imposed on the medical care institution, the nominal establisher, pursuant to paragraph (1) of the same Article (affirmative)
Summary of the holding
구 국민건강보험법(2020. 12. 29. 법률 제17772호로 개정되기 전의 것, 이하 같다) 제57조 제1항, 제2항에 따른 부당이득징수처분은 재량행위로서, 요양기관이 실시한 요양급여 내용과 요양급여비용 액수, 의료기관 개설·운영 과정에서 개설명의자와 실질적 개설자의 각 역할과 불법성의 정도, 의료기관 운영 성과의 귀속 여부와 개설명의자가 얻은 이익의 정도 등에 따라 개설명의자 등의 책임과 실질적 개설자의 책임이 달라질 수 있다. 한편 실질적 개설자에 대한 부당이득징수규정인 구 국민건강보험법 제57조 제2항 제1호의 요건으로서 구 의료법(2020. 3. 4. 법률 제17069호로 개정되기 전의 것, 이하 같다) 제33조 제2항이 금지하는 ‘비의료인의 의료기관 개설행위’는 비의료인이 의료기관의 시설 및 인력 충원·관리, 개설신고, 의료업 시행, 필요한 자금 조달, 운영 성과 귀속 등을 주도적으로 처리하는 것을 의미한다. 즉, 의료인인 개설명의자는 실질적 개설자에게 자신의 명의를 제공할 뿐 의료기관 개설과 운영에 관여하지 않으며, 그에게 고용되어 근로 제공의 대가를 받을 뿐 의료기관 운영에 따른 손익이 그대로 귀속되지도 않는다. 이 점을 반영하여, 구 의료법은 제33조 제2항 위반행위의 주체인 실질적 개설자를 10년 이하의 징역이나 1억 원 이하의 벌금에 처하도록 규정한 반면, 개설명의자에 관하여는 제90조에서 ‘의료기관의 개설자가 될 수 없는 자에게 고용되어 의료행위를 한 자’로서 500만 원 이하의 벌금에 처하도록 규정하고 있다. 이상과 같은 구 국민건강보험법 부당이득징수규정의 법적 성질·내용과 체계, 입법 취지, 그 규정에 따른 처분 시 고려 요소 등을 종합하면, 실질적 개설자는 부당이득징수처분에 따라 개설명의자와 독립하여 부당이득반환의무를 부담하되 개설명의자인 요양기관과 연대책임을 지는 관계에 있다. 그러므로 구 국민건강보험법 제57조 제2항에서 정한 ‘같은 항에 따른 징수금’이란, ‘실질적 개설자가 요양기관에 대한 종속적 지위에서, 요양기관에 부과된 부당이득징수금 범위 내에서 부담하는 징수금’이 아니라, ‘실질적 개설자가 요양기관을 통해 속임수나 그 밖의 부당한 방법으로 받은 보험급여비용 중 책임의 경중에 대한 재량적 판단을 거쳐 정해진 그 전부 또는 일부’를 의미한다. 결국 구 국민건강보험법 제57조 제2항 제1호에 따라 실질적 개설자로 하여금 개설명의자와 연대하여 납부하게 할 수 있는 부당이득징수금은, 책임의 경중에 대한 재량적 판단으로 말미암아 같은 조 제1항에 따라 개설명의자에게 부과되는 부당이득징수금을 초과하는 금액으로 정해질 수도 있다.
Order
상고를 모두 기각한다. 상고비용은 원고들이 부담한다.
Unofficial English translation
All appeals are dismissed. The costs of the final appeal shall be borne by the plaintiffs.
Provisions referred to
구 국민건강보험법(2020. 12. 29. 법률 제17772호로 개정되기 전의 것) 제57조 제1항, 제2항, 구 의료법(2020. 3. 4. 법률 제17069호로 개정되기 전의 것) 제33조 제2항, 행정기본법 제21조
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