Hello,
I think you are looking for the "OverwriteInstances" configuration option:
// Specifies how Orthanc reacts when it receives a DICOM instance
// whose SOPInstanceUID is already stored. If set to "true", the new
// instance replaces the old one. If set to "false", the new
// instance is discarded and the old one is kept. Up to Orthanc
// 1.4.1, the implicit behavior corresponded to "false".
"OverwriteInstances" : false,
Regards,
Sébastien-