THE Supreme Court (SC) ruled that the authority to revoke accreditation from healthcare providers lies exclusively with the Philippine Health Insurance Corporation (PhilHealth) Board of Directors, not with its president.
In a decision released on Nov. 12 and penned by Associate Justice Ramon Paul L. Hernando, the top court’s First Division ruled that under the National Health Insurance Act, only PhilHealth’s board has the power to withdraw or terminate accreditation.
“This power can only be exercised by the PhilHealth Board, and it requires a majority vote from its members,” it said in a statement.
The high tribunal clarified that the application for accreditation and revocation are two different processes.
“While the PhilHealth President may resolve applications, only the PhilHealth Board has the authority to act on withdrawals or revocations of accreditations,” it added.
The case stemmed from a spot inspection, in which PhilHealth’s fact-finding team found that a medical center had submitted fraudulent claims for patients who had already passed away.
The report said that a doctor from the center certified that one patient had undergone dialysis sessions after July 16, 2016, despite records showing the patient died on said date.
The doctor claimed that he and other medical staff were also victims of the center’s fraudulent practices, arguing that the two whistleblowers had publicly confessed to forging signatures to submit false claims for non-existent dialysis treatments.
PhilHealth later informed the doctor that his accreditation was revoked due to alleged misrepresentation involving false information.
He appealed the decision to PhilHealth’s regional office but was denied by the PhilHealth President and Chief Executive Officer.
He elevated the case before the Court of Appeals, ruling in his favor. The court said the revocation of his accreditation was invalid as it was issued without proper authority. — Chloe Mari A. Hufana
