The Board of the Philippine Health Insurance Corporation (PhilHealth) has the authority to revoke the accreditations of healthcare professionals, instead of its President, the Supreme Court (SC) said on Tuesday, November 12.
In a decision promulgated on August 19, 2024, the SC ruled that the corporation unlawfully revoked the accreditation of Dr. Jose Mari Del Valle Galauran. According to the higher court, an inspection from PhilHealth’s fact-finding department found that WellMed Dialysis and Laboratory Center Corporation (WellMed) submitted fraudulent claims for already deceased patients.
Dr. Galauran acted on behalf of WellMed and certified that Bebian Albante underwent dialysis sessions, despite the records showing that he had passed away. Additionally, Galauran argued that he, along with other doctors had also fallen victim to WellMed’s fraudulent activities.
Later on, PhilHealth notified Galauran that his accreditation had been revoked due to misrepresentation related to providing false information. Due to this, the SC upheld the decision of the Court of Appeals that his accreditation withdrawal was invalid.
“We emphasize that the basic application for accreditation is separate and distinct from the withdrawal or revocation of accreditation. 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,” the SC said.
Additionally, the SC said that the National Health Insurance Act and its implementing rules do not give the PhilHealth President the authority to revoke or withdraw a medical practitioner’s accreditation.
“This power can only be exercised by the PhilHealth Board, and it requires a majority vote from its members,” it said.
The Court also mentioned that healthcare providers will not be penalized when there is insufficient evidence.
“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,” it ended.
