THE Bacolod Our Lady of Mercy Specialty Hospital (BOLMSH)-Negros Health Care Management Services Inc. (NHMSI) filed a motion for reconsideration yesterday, June 25, before the Philippine Health Insurance Corporation (PhilHealth)-Western Visayas on the denial of its accreditation.
The motion dated June 25 was submitted by BOLMSH-NHMSI legal counsel Rafael Ocampo Jr. and its president Dr. Nestor Amante to PhilHealth-Western Visayas legal counsel Dennis Guevara at the City Mayor's Office in the Government Center (BGC) which was witnessed by Bacolod City Mayor Evelio Leonardia, BOLMSH executive assistant Victoria Angodung, Negrense Dialysis Group president Gregorio Gustilo, PhilHealth public relations officer Janimhe Jalbuna, City Health Officer Grace Tan, City Administrator John Orola, and City Legal Officer Joselito Bayatan.
The motion signed by Ocampo stated that they are filing the motion for reconsideration on the denial of the PhilHealth accreditation to take a second hard look on its decision on the ground that the denial is not supported by evidence and contrary to law or rules that the accreditation committee of PhilHealth Regional Office committed a serious error in denying the accreditation of NHMSI.
The PhilHealth letter of denial dated June 7, 2017, was only received by NHMSI on June 18 stating that the re-accreditation was denied due to "conviction of fraudulent acts."
Ocampo said the "conviction of fraudulent acts is a grave error on the part of PhilHealth because their client (NHMSI) was never convicted of fraudulent acts.
"The denial is not supported by evidence that NHMSI was ever convicted of fraudulent acts. The accreditation committee had mistaken our client NHMSI with Tiong Bi. Inc., the entity convicted of fraudulent acts. However, there is no evidence that NHMSI and Tiong Bi Inc. are the same entity," he said.
He added that even assuming, but without admitting and only for the sake of argument, that there is a ground to suspend NHMSI, the Rules of the National Insurance Act of 2013 provides that the decision shall be executory if public interest is involved. In this case, to execute the decision against Tiong Bi Inc. to NHMSI will result in the closure of the hospital, a situation that is even inimical to the public interest.
Ocampo noted that BOLMSH-NHMSI has earned the title as the hospital for the poor in Bacolod City. It provides the affordable services, particularly dialysis services.
"To implement the penalty to NHMSI will result to its closure. It will mean people will not be able to avail of affordable and high-quality services, this involves public interest," Ocampo said.
He said under Rules of the National Insurance Act of 2013, Section 59 (h) stated that the accreditation shall take effect prospectively. Claims for services before the effectivity of the accreditation and after the withdrawal of accreditation shall be denied.
The BOLMSH-NHMSI is requesting the PhilHealth that the denial on NHMSI's re-accreditation be reconsidered and set aside and a new order should be issued, approving the re-accreditation of BOLMSH until December 31, 2018; to release their PhilHealth claims for the months of March, April, May and June 2018; and other reliefs just and equitable under the circumstances are likewise prayed for.
The two parties had earlier agreed that pending resolution of the issues, BOLMSH will continue to operate until July 30, instead of closing down this week
Amante said that after he agreed on the extension of their operation, they already suffered losses, but until now they are still accepting patients for the community.
"We employed about 430 people and more than 200 dialysis patients so that's a lot for us, and enough reason to close," he said.
Ocampo said the separation due to the employees during the time their client operated or managed the hospital, they will be paid in accordance with the law that's a guaranteed to them.
For his part, Guevara said that the BOLMSH-NHMSI is aware of the provision in Section B-8 of the Performance Commitment that should there be any change in ownership or management of our institution shall not operate to exempt the previous and present owner or manager from liabilities for violations of RA No. 7875, as amended and its implementing rules and regulations.
He said they will endorse the BOLMSH appeal to the PhilHealth central office in Manila and they will deliberate it within one month, adding that they cannot release payment to the BOLMSH until such time the decision or the order will be reversed by the accreditation committee.
"Once the decision will be reversed, we do not have a problem, all the claims of the BOLMSH-NHMSI will be released, but if they will affirm the decision of the PhilHealth regional office, we will also work out to release their claims from the period of March until such time they received the copy of the decision which is June 18. We assure our members that we are financially stable," Guevara said.
Jalbuna said the validity of the accreditation starts from January 1 to December 31.
The Negrense Dialysis Group had earlier submitted their appeal to President Rodrigo Duterte to prevent the closure of the hospital. Ocampo said even if the president will order not to shut down, the shutting down or continuing the operation is the prerogative of the hospital, which they cannot render service at a loss.
"If the president will help, all he can do is to order the PhilHealth to accredit, but not to order the hospital to open at a loss. It's a management prerogative to open or close depending on how they see the business," he said.
Leonardia said he is thankful to the BOLMSH-NHMSI and PhilHealth officials for clarifying the issue.
"We do not want to disrupt medical services and the possible loss of jobs that could be a consequence of that closure. I salute the parties for a very amicable and professional way that we conducted the meeting last Friday," he said.
He added he is hopeful that it will be resolved completely, totally and permanently.
The mayor will also appeal the matter to PhilHealth.