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The process of revoking accreditation also requires a majority vote of the board members
MANILA, Philippines – The Supreme Court said board members of the Philippine Health Insurance Corporation (PhilHealth), not just its president, have the power to revoke the accreditation of health care professionals.
The ruling comes after a physician who was implicated in a hemodialysis corruption scandal got his licensed revoked “arbitrarily” by the state insurer.
The August 19, 2024 decision, released only on Tuesday, November 12, stems from a case involving Dr. Jose Mari Del Valle Galuaran, who got his licensed revoked by the PhilHealth president over “misrepresentation related to providing false information.”
The physician had been accused of acting on behalf of WellMed Dialysis and Laboratory Center Corporation — a hemodialysis center that was at the center of a controversy over fraudulent PhilHealth claims.
In the 20-page decision, the High Court emphasized that revocation of a health care professional’s accreditation with the state insurer requires a majority vote of PhilHealth’s board members.
“While the PhilHealth President may resolve applications, only the PhilHealth Board has the authority to act on withdrawals or revocations of accreditations,” the High Court said in a statement.
Ghost hemodialysis procedures
During its spot inspection in 2018, PhilHealth found that WellMed filed benefit claims worth P49,400 on November 2016 to cover a dead patient’s hemodialysis procedures on August and September 2016. The patient died in July 2016.
Galuaran allegedly certified records that the dead patient received treatment.
However, Galuaran pointed out that he wasn’t treating the patient as he was working for WellMed’s competitor, Eaglerock Dialysis and Wellness Center.
WellMed had been embroiled in a corruption scheme, which got its owner Bryan Sy and former WellMed officials-turned-whistleblowers Liezel Aileen De Leon and Edwin Roberto indicted for 17 counts of estafa through the falsification of official documents in June 2019.
Galuaran, along with other nephrologists, also accused WellMed of forging signatures for fraudulent benefit claims — an allegation backed by two whistleblowers. He also said he did not receive a copy of the alleged falsified document from PhilHealth that implicated him in the corruption scheme.
‘Unlawfully’ revoked accreditation
Despite not having enough evidence against Galuaran, PhilHealth still revoked his license on August 7, 2020. The physician’s appeal was also junked by the state insurer’s president and chief executive officer.
When Galuaran raised his case to the Court of Appeals, the court noted that the physician was not granted due process and that PhilHealth also failed to prove the accusations made against Galuaran.
This decision was echoed by the Supreme Court.
“The Court rules that PhilHealth arbitrarily and unlawfully revoked the accreditation of Dr. Galuaran and did not afford him due process,” the decision read. – Rappler.com
