BY GEROME DALIPE IV
ILOILO City – The Supreme Court has ruled that the PhilHealth Board — not its President — holds the authority to revoke the accreditation of healthcare professionals. This decision came after the case of Dr. Jose Mari Del Valle Galauran, whose accreditation was revoked by PhilHealth.
In the ruling, written by Associate Justice Ramon Paul L. Hernando, the SC’s First Division found that PhilHealth acted unlawfully in revoking Dr. Galauran’s accreditation, as the decision to revoke accreditation lies with the PhilHealth Board, not the President of PhilHealth.
PhilHealth, as the administrator of the National Health Insurance Program, is responsible for setting the requirements and issuing guidelines for accrediting healthcare providers, the tribunal explained.
In this case, the situation involved WellMed Dialysis and Laboratory Center Corporation (WellMed), which was found to have submitted fraudulent claims for patients who were already deceased.
Following a spot inspection, PhilHealth’s fact-finding department discovered that Dr. Galauran, acting on behalf of WellMed, certified that Bebian Albante, a patient who had died on July 16, 2016, underwent dialysis sessions even after that date.
The fraudulent claims were discovered through a review of patient records, which clearly showed Albante had passed away on the same day he was supposedly receiving dialysis treatment.
The submission of these claims prompted PhilHealth to take action, but the tribunal ruled that the PhilHealth Board—not the President—had the authority to revoke Dr. Galauran’s accreditation.
In his defense, Dr. Galauran argued that he, along with other doctors, was also a victim of WellMed’s fraudulent activities.
He explained that two whistleblowers had publicly confessed to forging signatures for fraudulent benefit claims related to non-existent dialysis treatments.
Dr. Galauran contended that he was unaware of these fraudulent actions and was misled by the company.
PhilHealth, however, notified Dr. Galauran that his accreditation had been revoked due to misrepresentation and providing false information related to the fraudulent claims.
He then appealed the decision to the PhilHealth Regional Office in the National Capital Region, but his appeal was denied by the PhilHealth president and chief executive officer.
Dr. Galauran subsequently brought his case to the Court of Appeals (CA), which ruled in his favor.
The CA determined that the revocation of his accreditation was invalid, as it was issued without lawful authority. According to the ruling, the authority to revoke accreditation lies with the PhilHealth Board, not the PhilHealth President.
The high court upheld the Court of Appeals’ decision. According to the ruling, both the National Health Insurance Act and its implementing rules specify that this power resides solely with the PhilHealth Board, and it requires a majority vote from its members to take such an action.
The high court clarified that accreditation and revocation are distinct processes. While the PhilHealth president has the authority to resolve applications for accreditation, only the PhilHealth Board can act on the withdrawal or revocation of accreditations.
The tribunal also ruled in favor of Dr. Galauran, stating that PhilHealth failed to prove any wrongdoing on his part.
The tribunal pointed out that the evidence showed that Albante’s attending physician was someone other than Dr. Galauran, and there was no report prepared by him for Albante.
This lack of direct involvement in the fraudulent claims was crucial in the court’s decision.
In its ruling, the high court also held that it would not penalize healthcare providers without sufficient evidence of misconduct.
“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 and well-being,” read the SC ruling./PN
