60win SC: PhilHealth chief can’t revoke healthcare professionals’ accreditation

MANILA, Philippines — The Supreme Court (SC) has ruled that the president of the Philippine Health Insurance Corporation (PhilHealth) has no authority to revoke accreditations of health care professionals (HCP).

Based on a decision written by Associate Justice Ramon Paul Hernando, the power to revoke accreditation can only be exercised by the PhilHealth Board, which would then require a majority vote from its members.

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“The Court clarified that the application for accreditation and its revocation are two distinct processes. While the PhilHealth President may resolve applications, only the PhilHealth Board has the authority to act on withdrawals or revocations of accreditations,” the SC Information Office said, citing the decision.

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The High Court’s decision affirmed a Court of Appeals (CA) ruling involving an unlawful revocation of the accreditation of an HCP by PhilHealth.

PhilHealth revoked the HCP’s accreditation after they were found involved in a corporation’s submission of fraudulent claims for deceased patients.

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The HCP, for his part, argued that he is also a  victim. He also cited two whistleblowers who admitted to forging signatures for the fraudulent claims.

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The HCP then appealed his revocation to the PhilHealth Regional Office in the National Capital Region, but was denied by the PhilHealth president and chief executive officer.

He elevated the case to the CA, which ruled in his favor.

In affirming the CA ruling, the SC also pointed out that PhilHealth failed to prove that the HCP did anything wrong.

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