NBI files raps vs. PhilHealth officials on HCP accreditation row

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THE National Bureau of Investigation-Anti-Graft Division (NBI-AGD) has filed charges against officers of PhilHealth Regional Office – National Capital Region (PRO-NCR) Accreditation Committee before the Office of the Ombudsman in relation to Health Care Provider (HCP) accreditation renewal.

NBI Officer-In-Charge Eric Distor identified the PRO-NCR officials and personnel as Dr. Nenita Epifania Balbuena, Dr. Imelda Trinidad De Vera-Pe, Janice Gem Perlas, MD, Rofien Ison, MD, Diode Lantora, Atty. Yasser Ismail Abbas, Allan De Villa, Alejandrino Perez, MD, Jeffrey Pe, Dennis Mas, and Dr. Celestina Ma. Jude Dela Serna.

Distor said that in October 2016, the complainant received a letter from Mas, Vice President of PRO-NCR, to inform her that her application for re-accreditation was denied by the PRO-NCR Accreditation Sub-Committee from July 1, 2016 to June 4, 2019 due to practice inconsistent with the acceptable quality of care.

In May 2017, the complainant, through Atty. Paulo Selva, requested the NBI to conduct an investigation on the alleged injustice committed by PRO-NCR officials on the HCP re-accreditation. However, in July 2017, the complainant withdrew her complaint as she received verbal advice from Dr. Dela Serna, former Interim/Officer-In-Charge, President and CEO of the Philippine Health Insurance Corp. (PHIC) that she will be accredited as HCP if she withdrew her complaint.

However, in September 2020, complainant requested for a revival of the case as the re-accreditation did not push through.

The notice of denial was dated October 13, 2016 but the Accreditation Sub-Committee denial order was ante-dated from July 1, 2016 to June 4, 2019. Minutes of Accreditation Sub-Committee Meeting PRO-NCR dated October 10, 2016 was deliberated, approved, and signed by the Sub-Committee NCR Members

It shows that the denial was August 3, 2016.

According to the PHIC, the denial is due to the administrative case filed against the complainant with the PHIC’s Prosecution Department. The complainant, however, claimed that she was denied due process guaranteed under the National Health Insurance Act of 1995, the grounds used for the denial was not explained well and there were no specifics given. She was not also informed or notified of any inquiry or validations made by the PHIC. Further, PHIC was not able to resolve the allegations against her after serving the suspension from July 2016 to June 2019.

Looking at the circumstances on how the renewal of accreditation was denied, it appears that the Accreditation Sub-Committee agreed to reopen the deliberation on the application for accreditation and unanimously voted to recommend the denial of application for accreditation. Also, at the time the denial was made, there was no pending case filed against the complainant.

Further investigation revealed that the basis of denying the application for accreditation was not sufficiently established by PhilHealth. PhilHealth’s authority to deny accreditation of complainant requires that the applicant be first convicted of fraudulent acts. From the records, it appeared that the complainant was denied her accreditation even before the case was heard by the Arbitration Office and without a formal complaint and an effort to conduct a fact-finding investigation as mandated by NHI Law.

While it is within the PhilHealth’s power to suspend, revoke, or refuse accreditation, it must be emphasized that the power to suspend or revoke is exercised based on the existence of grounds and must be compliant with governing law. PhilHealth must observe due process in that it must afford the applicant notice and opportunity to be heard.

NBI-AGD then recommended that the officials be prosecuted for violation of Section 3(e) of RA 3019 (Anti-Graft and Corrupt Practices Act), and were also recommended to be administratively charged for violation of RA 6713 (Code of Conduct and Ethical Standards for Public Officials and Employees).

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