SC orders PhilHealth to reinstate QC Eye Center, pay claims
THE SUPREME COURT (SC) has ordered the Philippine Health Insurance Corp. (PhilHealth) to lift its suspension against the Quezon City Eye Center and to settle all unpaid claims related to cataract operations conducted between July 2009 and June 2010.
In a 30-page decision dated Feb. 6 and made public on June 13, the tribunal said there was no evidence presented that would hold the medical institution liable for supposedly engaging in unethical practices as an accredited health care provider.
“There is no substantial evidence showing that it (Quezon City Eye Center) directly or indirectly solicited patients for cataract screening, operation, and treatment during medical missions or under any circumstance prohibited under Circular No. 19, series of 2007 as to render it liable for Breach of the Warranties of Accreditation,” according to the ruling penned by Justice Amy. C. Lazaro-Javier.
PhilHealth had issued a circular that ordered the suspension of claims for cataract operations performed during medical missions and through “other cataract sweeping recruitment schemes.”
It said it was acting on reports of supposed irregularities in the recruitment of patients that stemmed from a complaint from a group of doctors.
In 2015, the PhilHealth Arbitration Office ordered the suspension of Quezon City Eye Center’s accreditation after it was found that one of its ophthalmologists performed a total of 1,179 operations from July 2009 to June 2010.
The firm argued that it had entered into an agreement with Heidelberg Ventures Corp., an independent group of ophthalmologists, to only lease its facilities to their doctors to treat patients, which the court agreed with.
“In this light, the Court will not penalize health care providers, whereas in this case, there is an abject lack of substantial evidence to support a finding of administrative liability against the petitioner for Breach of the Warranties of Accreditation,” the tribunal said.
“To do otherwise would ultimately result in the deprivation of the right of the people to health and patient care services and the chance to have a better quality of life and well-being.” — John Victor D. Ordoñez
