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PhilHealth has the authority to accredit: DOJ
According to the Department of Justice (DOJ), the government-run Philippine Health Insurance Corp. (PhilHealth) has the authority to decide which healthcare providers are eligible for accreditation under its programs, including whether to reinstate the accreditation of businesses that had it revoked.
Justice Secretary Jesus Crispin Remulla stated in a seven-page legal opinion that “PhilHealth has the power to withdraw a health care provider’s accreditation permanently or to reinstate its accreditation, depending on its (PhilHealth’s) findings and assessment.”
The decision was given to Atty. PhilHealth Officer-In-Charge. Eli Dino Santos asked the DOJ for advice on the scope of PhilHealth’s authority to revoke the accreditation of healthcare providers for violations of RA No. 7875, the National Health Insurance Act of 1995, and RA 10606, which amended the statute as mentioned earlier.
Remulla pointed out that, in accordance with the aforementioned legislation, PhilHealth has the authority to establish the definitions of particular healthcare provider violations and the guidelines for preventive suspension and revocation of the accreditation contract.
The DOJ continued, saying that the punishment of accreditation revocation is only applied to medical professionals who are deemed repeat offenders and that “the legislation expressly provides that repeat offenders may not be accredited or contracted as members of the program.”
PhilHealth “may lift the penalty of revocation of accreditation imposed upon the respondent health care provider, if based on its assessment the erring health care provider has already faithfully complied with all its requirements and guidelines,” according to the DOJ. “The use of the word may make the provision permissive,” the DOJ stated, adding that as a result, the penalty is not mandatory but discretionary.***
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