THE Philippine Health Insurance Corporation (PhilHealth) imposes a three-month suspension of the accreditation of Adventist Hospital Cebu, Inc. (formerly H.W. Miller Memorial Sanitarium and Hospital) located at Tres De Abril Street, San Nicolas, Cebu City.
Adventist Hospital Cebu, Inc. is meted with the penalty of suspension of three (3) months of its accreditation with PhilHealth and fine of Php 10,000 for misrepresentation by furnishing false or incorrect information and breach of the warranties of accreditation based on Section 144 and 150 of the Implementing Rules and Regulations of Republic Act No. 7875.
The case stemmed from the findings of the Accreditation Section of PhilHealth Regional Office 7 in 2007 during an inspection for renewal of accreditation of then H.W. Miller Memorial Sanitarium and Hospital (Miller).
It was found out that dialysis clinic SouthMed Dialysis Center, Inc. (SMDC), a tenant of the hospital, filed dialysis claims through Miller. Although there was a contract of lease between both facilities, there was no memorandum of agreement stating SMDC as an outsourced service unit of Miller. Through a fact-finding investigation report, PhilHealth 7 Legal Office recommended filing a case to its Head Office against the hospital for Misrepresentation by Furnishing False or Incorrect Information.
In 2009, PhilHealth Head Office’s Prosecution Department filed the complaint about Misrepresentation by Furnishing False of Incorrect Information, a violation of PhilHealth Circular No. 17, s-2006, and Breach of the Warranties of Accreditation under Sections 144 and 150 of the Implementing Rules and Regulations of Republic Act 7875.
It was also found out that two anomalous benefit claims were made to appear that hemodialysis sessions of a patient were performed at Miller where in fact were done at SMDC.
PhilHealth initially rendered a decision of finding the hospital guilty on two counts of Section 144 and meted the penalties of suspension of accreditation of six months and a fine of Php 20,000 and the denial of two claims of the dialysis patient.
As the hospital filed a Notice of Appeal with Memorandum of Appeal, the PhilHealth Board in 2013 issued a resolution modifying the Arbiter’s decision. In effect, the penalties were reduced to three months suspension and a fine of Php 10,000.
In 2013, then Miller hospital filed a Motion to Dismiss, while Adventist Hospital Cebu, Inc. which took over the operations, assets and liabilities of Miller, filed a Manifestation with Motion for Reconsideration in 2016, but the same were denied by the PhilHealth Board.
The hospital also filed a petition for review and a motion for reconsideration to the Court of Appeals (CA) but the CA denied the same in 2017. It then filed an appeal in the Supreme Court (SC) but the SC denied the petition of being unmeritorious and affirmed the CA decision.
PhilHealth 7 Legal Office received the Order and Writ of Execution of the case against Adventist Hospital Cebu, Inc. from its Head Office’s Arbitration Department in May 2021. The order was served to the hospital’s president on June 1, 2021.
The order states that the implementation of suspension of accreditation shall take effect on August 1, 2021 up to October 29, 2021. Within these dates, PhilHealth will not receive, process, nor pay any claims from Adventist Hospital Cebu, Inc. Members are advised to seek medical services in other accredited health care institutions in the area. (PR)