SC: PhilHealth president can't revoke accreditation of healthcare professionals

The Board of the Philippine Health Insurance Corporation (PhilHealth), and not its president, has the power to revoke the accreditation of healthcare professionals (HCP), the Supreme Court (SC) ruled.

In a 20-page decision, the SC First Division said it is clear that the powers to revoke an accreditation are exercised by the PhilHealth Board under Section 75 of the Revised Implementing Rules and Regulations (RIRR) of the National Health Insurance Act.

"We emphasize that the basic application for accreditation is separate and distinct from the withdrawal or revocation of accreditation," the SC said.

"While the basic application for accreditation can be resolved by the PhilHealth President and CEO, only the PhilHealth Board, exercising its quasi-judicial power, can act on the withdrawal or revocation of accreditation," it added.

GMA News Online has sought comment from PhilHealth but has yet to receive a response as of posting time.

The SC issued the ruling as it affirmed the decision of the Court of Appeals that found that PhilHealth unlawfully revoked the accreditation of a healthcare professional.

"Applied to the case at bar, the withdrawal or revocation of… [the] accreditation was arbitrary and without lawful authority. It is therefore a patent nullity," it said.

According to the high court, PhilHealth revoked the HCP's accreditation after it found that the HCP was allegedly acting on behalf of a corporation that submitted fraudulent claims for patients who were already deceased.

However, the HCP argued that he and other doctors were also victims of fraudulent activities. The HCP stressed that two whistleblowers admitted to forging signatures for the fraudulent benefit claims.

In its ruling, the High Court also stressed that PhilHealth failed to prove by substantial evidence that the HCP violated the RIRR.

"The Court will not penalize HCPs when there is a clear lack of evidence to support a finding of administrative liability for misrepresentation by furnishing false or incorrect information," the SC said.

"We will not deprive the public of their right to health and patient care services, as well as the chance to have a better quality of life," it added.

The decision was promulgated in August but published only in November. — VDV, GMA Integrated News