NextGen Day

Cardinal Santos Medical Center’s appeal against a PHP10,000 fine and a three-month suspension imposed by the Philippine Health Insurance Corp. (PhilHealth) on the hospital was denied by the Court of Appeals (CA).

In a decision dated January 11, 2023, the appeal court rejected the hospital’s move for reconsideration that challenged an earlier CA ruling from May of last year that upheld the hospital’s fine and three-month suspension by PhilHealth for the administrative violation of filing repeated claims.

The CA stated that it does not perceive a need to modify PhilHealth’s case-related conclusions.

The court stated that “the extensive exercise of the Court’s power to review is not called-for” because the courts “will not be interfered with by the findings of fact of quasi-judicial bodies in the absence of grave abuse of discretion or when the same is supported by substantial evidence, as in this case.”

Additionally, the 19 administrative proceedings brought against the company, all of which were for breaking PhilHealth legislation, “belie its claim of having an excellent track record,” the statement continued.

The hospital had contested CA’s previous judgment against it from May 24, 2022, which rejected its petition to reverse the PhilHealth Board’s resolution No. 2492 decision affirming the PhilHealth Arbitration Office’s finding that it was liable for filing repeated claims.

In one instance, different claims were made for Leonora Goco’s radiotherapy treatment, which was the subject of the event.

The hospital submitted two claims: one on January 3, 2012, for PHP 4,156, and the other, for PHP 4,202, on January 17, 2021.

Hospital Managers Inc., not Colinas Verdes Hospital Managers Corp., according to the hospital, operated and managed the facility at the time of the incidents that led to the administrative crimes.

The court stated that the claim “is immaterial” because the petitioner (hospital) is the legal entity that got a PhilHealth accreditation and, as a result, the entity is subject to PhilHealth’s rules and regulations, regardless of who its management or operator is.

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